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Hepatotoxicity of Psychotropic Drugs
table  1.   Hepatotoxicity Caused by Psychotropic Drugs
Drug Type of
Injury 		Incidence Latency Probable Mechanism
Phenothiazines
  Chlorproma- CH 0.1%-1% 1-5 weeks Hypersensitivity
  zine (up-arrow ALT only 25%-50%)   idiosyncratic?
Butyrophenones
  Haloperidol CH 0.002% 4-5 weeks Hypersensitivity
(up-arrow ALT only 16%)
Misc. neuroleptics
  Clozapine HC rare 5 weeks unclear
(up-arrow ALT only 37%)
Benzodiazepines
  Diazepam CH or HC rare days-months Hypersensitivity
  Chlordiazepoxide 2-6 weeks
Barbiturates
  Phenobarbital CH or HC rare 1-8 weeks Hypersensitivity
MAO inhibitors
  Phenelzine HC rare weeks unclear
Tricyclic antidepressant
  Amitriptyline CH or HC 0.5%-1% 8 weeks Hypersensitivity
  Imipramine (up-arrow ALT only 10%) 1-3 weeks
  Desipramine 1-3 weeks
  Amineptine HC rare 2-3 months Hypersensitivity
Other antidepressants
  Trazodone HC or CH rare 2-20 weeks unclear
  Nefazodone HC rare 14-28 weeks unclear
Acetylcholinesterase inhibitors
  Tacrine HC ALT > 3-fold 20% ALT > 20-fold 2% up to 12 weeks idiosyncratic
SSRI Fluoxetine
  Fluoxetine HC rare 4 weeks unclear
Drugs of abuse
  Cocaine HC unknown hours
  to days		 ischemic vs. toxic metabolite
  Ecstasy HC unknown hours
  to weeks		 unclear
NOTE. Rare = one or few isolated reports. Hypersensitivity based on presence of clinical features.
Abbreviations: CH, cholestatic; HC, hepatocellular.

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