Can Sertraline Damage Your Liver? (3+ Management Strategies)

This article explores the impact of sertraline on liver health, including the occurrence of rare liver damage. It discusses its mechanism, case studies, symptoms, factors influencing its occurrence, and management strategies.

Can sertraline damage your liver?

Yes, sertraline can damage the liver. However, hepatotoxicity caused by sertraline is rare compared to other similar medications. Only a small number of cases, fewer than 10, have been reported in medical literature [1].

The presentation of liver injury caused by sertraline can range from mild liver dysfunction without symptoms to more severe hepatitis. Symptoms that may occur include abdominal pain and jaundice (yellowing of the skin or eyes) [1].

The liver function typically improves after stopping sertraline, although the time it takes to normalize can vary, sometimes taking up to 6 months [1].

How does sertraline affect the liver?

Long-term administration of sertraline can lead to significant morphological and histological changes in the liver, potentially affecting its function. It is also suggested that sertraline may reduce the expression of drug and arachidonic acid-P450 metabolizing enzymes [2].

Like other antidepressants, sertraline inhibits cytochrome P450 2D6, to a lesser extent at lower doses. The inhibition of this enzyme can potentially lead to the accumulation of other drugs, causing hepatotoxicity or worsening the hepatotoxic effects of sertraline [1].

What are the reported cases of sertraline-related liver damage?

A pregnant woman was referred to a hospital with abnormal liver function tests (LVT), having symptoms like dark urine, epigastric discomfort, vomiting, and mild itching. Acute hepatitis caused by sertraline, which she had been taking, was suspected [3].

The patient’s biochemical and histopathological results, along with the improvement in LVT after stopping sertraline, supported this diagnosis. In addition, no other underlying liver pathology was found through imaging and extensive investigations [3].

Furthermore, a 17-year-old boy taking sertraline developed symptoms of nausea, fatigue, jaundice, and dark urine.

After stopping sertraline, the symptoms persisted for 2 weeks. Serial liver tests revealed a gradual decline in aminotransferase levels, which returned to normal within 6 months. There were no relapses in the symptoms after discontinuation during the follow-up period [4].

Lastly, a woman was hospitalized after experiencing symptomatic hepatitis while administering sertraline. Based on serologic, imaging, histologic, and temporal evidence, it is likely that sertraline toxicity was the cause.

Moreover, a liver biopsy conducted during her hospital stay revealed histologic changes consistent with drug-induced hepatitis [5].

In addition, discontinuing sertraline led to a significant decline in her ALT level after 4 weeks. Notably, reintroducing sertraline caused a prompt increase in ALT levels, confirming drug-induced liver injury. The patient’s ALT level returned to normal after permanently stopping sertraline [5].

How to know if sertraline is affecting your liver?

• Jaundice: this is a yellowing of the skin and eyes due to the buildup of bilirubin, a yellow pigment, in the body. It is a common sign of liver damage caused by sertraline [3] [4].
• Abdominal pain and swelling: sertraline-induced liver damage can cause pain and discomfort in the upper right side of the abdomen [3] [4].
• Nausea and vomiting: nausea is a commonly reported symptom of sertraline-related liver injury [3]
• Changes in stool color: such as the presence of pale stools or dark, tar-like stools.
• Itchy skin: the buildup of toxins and the liver’s inability to produce bile can lead to itching [3].
• Fluid retention
• Abnormal liver function test results: these include ALT, AST, ALP, total and direct bilirubin, albumin, and GGT.

Remember, these symptoms can differ depending on the specific type and stage of sertraline-related liver damage. It is important to consult a medical professional for proper diagnosis and treatment.

What factors influence sertraline-related liver damage?

Some medications can affect liver damage caused by sertraline, as is known to inhibit the enzyme cytochrome P450 2D6 (CYP 2D6). Thus, when taken along with drugs metabolized by this enzyme, it can potentially lead to liver injury. The commonly prescribed drugs that are metabolized by CYP 2D6 include:

• Ondansetron
• Codeine
• Tramadol
• Fluoxetine
• Paroxetine
• Amitriptyline
• Nortriptyline
• Venlafaxine, etc.

It’s important to note that there may be other medications not mentioned here that can be affected by sertraline’s inhibition of CYP 2D6. Consulting a healthcare professional or pharmacist about your medication is recommended to fully understand potential drug interactions and associated risks.

How can you manage sertraline-induced liver toxicity?

When managing drug-induced liver injury, the following recommendations may be considered:

Consult with your healthcare provider

If you experience any symptoms of liver injury or have any concerns about it, you must consult with your doctor before making any adjustments to your medications.

They will explore any other underlying reasons and will guide you about what you should do. In severe cases, referral to a hepatologist or specialist in liver diseases may be warranted.

Discontinue sertraline

The first step is to stop the use of the sertraline. However, do not do so abruptly. Your healthcare provider will typically create a tapering schedule, gradually reducing the dose of sertraline over a specific period. This helps minimize withdrawal symptoms and allows your body to adjust gradually

Monitor liver function

Regular monitoring of liver function tests, including the levels of ALT, AST, ALP, GGT total and direct bilirubin, and prothrombin time, is essential to track liver recovery.

Consider other antidepressants that are safe for the liver

A doctor may consider alternative antidepressant medications that are considered safe for liver function. According to an article in the International Journal of Development Research, desvenlafaxine, the synthetic version of venlafaxine’s active metabolite, is one of the safest antidepressants for patients with liver disease.

This is due to its high percentage of elimination in the urine without alteration. In addition, dose adjustments can be done in case of liver damage. For instance, the typical maximum daily dose of 200mg should be reduced to 100mg for patients with liver failure.

However, it’s important to note that the choice of an appropriate alternative medication will depend on the individual patient’s specific circumstances and the professional judgment of their doctor.

Conclusion

Sertraline has been associated with rare cases of liver damage, although it is less common compared to other similar medications. Symptoms of liver injury may range from mild dysfunction to more severe hepatitis, including abdominal pain and jaundice.

The liver function typically improves after stopping sertraline, and normalization can take up to 6 months. Chronic use of sertraline can lead to morphological and histological changes in the liver. It can also inhibit cytochrome P450 2D6, potentially affecting the metabolism of other drugs.

Monitoring liver function and following a tapering schedule to discontinue sertraline under the guidance of a healthcare provider are important steps in managing sertraline-induced liver toxicity.

Alternative antidepressants that are safe for the liver, like desvenlafaxine, may be considered based on medical judgment.

References