Mechanism of Injury The mechanism by which citalopram and escitalopram cause liver injury is not known. Citalopram and escitalopram are extensively metabolized by the liver, mainly via the cytochrome P450 system (CYP 3A4, 2D6 and 2C19) and hepatotoxicity may be mediated by toxic intermediates of their metabolism.
Although thought to be generally safe and with minimal drug-drug interactions, clinicians should be aware of the possibility of escitalopram-induced liver injury when initiating depressed patients on antidepressant treatment. This requires extra vigilance as most patients may remain asymptomatic.
The best antidepressant options for patients with liver failure is desvenlafaxine. This drug is an active metabolite of venlafaxine, with high percentage of unchanged metabolites eliminated in the urine.
Clinicians should be aware of the possibility of drug-induced liver injury associated with escitalopram use, when initiating depressed patients on antidepressant treatment.
Lorazepam is metabolized by the liver to inactive metabolites and is considered the benzodiazepine best tolerated by patients with advanced liver disease.
Early Signs of Liver Damage from Medication
Fever. Diarrhea. Dark urine. Jaundice, a condition that occurs when a substance called bilirubin builds up in the blood and causes the skin and whites of the eyes to appear yellow.
Fluoxetine, paroxetine, sertraline, citalopram, and fluvoxamine are SSRIs mostly linked with hepatotoxicity (Table 1). SNRIs venlafaxine and duloxetine, as well as SARI trazodone, are also strongly associated with hepatotoxic side-effects.
Ordinarily, treatments presumed to be associated with a greater risk of hepatotoxicity (iproniazid, nefazodone, tianeptine, phenelzine, imipramine, amitriptyline, duloxetine, bupropion, trazodone, and agomelatine) should not be initiated in individuals with preexisting liver failure.
Acetaminophen. Taking acetaminophen in excess is the leading cause of drug-induced liver injury.
Fluoxetine, paroxetine, sertraline, citalopram, and fluvoxamine are SSRIs mostly linked with hepatotoxicity (Table
Escitalopram is not approved for use by anyone younger than 12 years old. Ask your doctor about taking this medicine if you are pregnant. Taking an SSRI antidepressant during late pregnancy may cause serious medical complications in the baby.
Lexapro may cause serious or life-threatening side effects such as birth defects, heart conditions, serotonin syndrome, and an increased risk of suicide. These severe side effects linked to Lexapro have been the basis of lawsuits filed against the manufacturer.
As the liver becomes more severely damaged, more obvious and serious symptoms can develop, such as: yellowing of the skin or whites of the eyes (jaundice) swelling in the legs, ankles and feet caused by a build-up of fluid (oedema) swelling in your abdomen caused by a build-up of fluid known as ascites.
SSRI's are anti-depressants and are currently the most popular anti-depression / anti-anxiety drugs as they have fewer side effects than MAOI's. SSRI's include drugs such as Prozac, Luvox and Aropax. SSRI's must be taken on a daily basis for at least a few weeks before they are effective.
How long can you take Lexapro? If this is your first episode of depression, your doctor may prescribe Lexapro for a set period, for example, 6 months to a year. Some people with persistent depression may need to take it for many years. There are no known problems when Lexapro is taken long-term.
Lexapro is usually taken for a period of many years, either until a person feels that they don't need it anymore or until they begin experiencing negative side effects and decide to switch medications.
For people with chronic or severe depression, medication may be needed on a long-term basis. In these cases, antidepressants are often taken indefinitely. That is, in part, because depression is not an illness that can be cured.