Hepatoxicity Induced by Clozapine: Case Report and Brief Review

Abstract

Introduction: Antipsychotics are drugs that can produce transient elevations of hepatic enzymes. Clozapine is an atypical antipsychotic used in treatment-resistant schizophrenia and there is evidence that it can produce elevations of hepatic transaminases, expression of liver damage in a hepatocellular pattern.

Methods: Case report and non-systematic review of the relevant literature.

Case presentation: A 39-year-old woman with a diagnosis of paranoid schizophrenia attended the emergency department of a general hospital for nausea, vomiting and jaundice that appeared after the initiation of clozapine. There was no clinical improvement during hospitalisation, and death occurred after 44 days.

Literature review: Clozapine can increase the liver enzyme levels transiently and asymptomatically; however, there are clinical criteria that recommend the withdrawal of the antipsychotic.

Conclusions: This is the third case reported in the literature of a fatal outcome of clozapine-induced hepatotoxicity.

Keywords: Adverse event; Antipsicóticos; Antipsychotic agents; Drug-induced liver disease; Enfermedad hepática inducida por medicamento; Evento adverso.