SHM Converge Scientific Abstract ePoster Gallery-Duloxetine Dilemma: Unmasking the Hidden Threat of Liver Injury

Pdf Summary

This case report describes a 70-year-old woman with fibromyalgia, SLE, and Paget’s disease who developed significant liver enzyme elevation while taking duloxetine 60 mg daily for four months. She was admitted with altered mental status after two weeks of symptoms. She had no alcohol use, viral illness, or exposure to other known hepatotoxic substances. Her other medications included mycophenolate mofetil, hydroxychloroquine, acetaminophen, and levetiracetam.<br /><br />Initial liver tests showed mild abnormalities, but peak labs revealed marked transaminitis: ALT 540 U/L, AST 450 U/L, and ALP 321 U/L, with normal bilirubin and GGT. Workup for viral hepatitis and autoimmune liver disease was negative. Imaging, including RUQ ultrasound with Doppler and elastography as well as CT abdomen/pelvis, was unremarkable. After duloxetine was stopped, liver function tests returned to baseline within two weeks and remained normal at six weeks. A liver biopsy was not pursued because of clinical improvement.<br /><br />The report highlights that duloxetine-induced liver injury is uncommon but can present with hepatitis and substantial transaminase elevations. The mechanism is thought to involve both idiosyncratic immune reactions and dose-dependent, metabolism-related toxicity. Available data suggest liver injury often occurs around 50 days after starting therapy, and higher doses may increase risk.<br /><br />The authors conclude that duloxetine-induced hepatotoxicity should be considered in patients with unexplained liver enzyme elevation while receiving the drug. They recommend baseline liver function testing and repeat monitoring four to six weeks after starting duloxetine or after dose changes.

Asset Subtitle

Asma Mohammadi

Meta Tag

Author List Asma Mohammadi

Category Clinical Vignettes

Concept Duloxetine

Concept Drug-Induced Liver Injury

Concept Hepatotoxicity

Concept Aminotransferase Elevation

Concept Liver Function Tests

Distinguished Non-Finalist

Presenter Organization Upmc

Presenting Author Asma Mohammadi

Track Adult

Keywords

duloxetine

hepatotoxicity

liver injury

transaminitis

elevated liver enzymes

drug-induced liver injury

fibromyalgia

systemic lupus erythematosus

baseline liver function testing

ALT AST elevation

Duloxetine

Drug-Induced Liver Injury

Hepatotoxicity

Aminotransferase Elevation

Liver Function Tests