Haloperidol-induced Cytolytic Hepatitis

Abstract

Contrary to phenothiazines, butyrophenones are very seldom associated with hepatitis. In particular, the incidence of hepatitis on haloperidol is about 0.002%. Almost all these cases consisted of cholestatic hepatitis. Cytolytic hepatitis induced by haloperidol seems to be exceptional. Objective: To outline the occurrence of haloperidol-induced cytolytic hepatitis. Methods: Case report and review Results: We report the case of a male patient aged 22, with a family history of schizophrenia in two cousins and with a personal history of generalized epilepsy on carbamazepine. The patient was admitted to our department for behavioral disturbances. Psychiatric interview found mystical and grandiosity delusions as well as auditory and visual hallucinations. The patient was started on haloperidol 5mg bid. Routine liver enzymes obtained on day-10 revealed eight-fold elevated transaminases with no associated biological signs of cholestasis. The patient did not report any symptoms suggestive of hepatitis. Serology for viral hepatitis (A, B, and C), EBV and CMV was negative. Hepatic ultrasound examination was normal. Antinuclear, anti-LMK and anti-mitochondrial antibodies were negative. Serum and urine copper levels were normal. The diagnosis of a drug-induced hepatitis was made. Haloperidol was withdrawn and switched to olanzapine. Transaminase levels slowly dropped then normalized within two months, thus consolidating our diagnosis. Conclusions: Cytolytic hepatitis induced by haloperidol is very rare and can be asymptomatic. Routine liver tests when starting antipsychotics are crucially important to diagnose this possibly hazardous side effect.

Acute transaminitis after initial days of starting haloperidol

“…This is not the first case of an acute haloperidolinduced transaminitis, Ouanes et al had a similar report showing an eight-fold increase in transaminases (with ALT>AST) 10 days after initiating treatment with haloperidol. 8 This case study adds further support with of an acute haloperidol transaminitis with worsening hepatitis with subsequent trials. The temporal association between initiating haloperidol treatment and the transaminitis, in the context of negative serologies and a controlled environment, yields strong evidence for the consideration of haloperidol as a culpable agent in elevated liver enzymes.…”

“…Acute haloperidol-induced transaminitis is not well studied, with only one case report presuming the drug was the culprit due to the context of negative serology and liver scan. 8 In this case, we provided temporal relation to starting and stopping haloperidol with the rise and fall of liver enzymes. The patient was asymptomatic throughout the time course, had negative hepatic serologies, and was able to fully recover.…”

Development of acute hepatotoxicity following the first dose of paliperidone palmitate: a case report

“…Moreover, acute-onset delirium was seen after the second PP dose in an adolescent with schizophrenia (13). In our case, the use of the LAI form of haloperidol was not considered due to transaminitis reported in the literature (20)(21)(22). Risperidone-induced hepatotoxicity has also been reported in another patient using synthetic cannabinoid (23).…”