A case report of a probable drug-induced liver injury after therapy remodulation with lamotrigine, quetiapine and sertraline in an adult female with recurrent major depression using the updated RUCAM score

Background

Drug-induced Liver Injury (DILI) is a common cause of acute liver injury and can be induced by several drugs. Lamotrigine, an antiepileptic drug, and quetiapine are used also as mood stabilizer medications and both have been reported to induce liver toxicity. The prescription of lamotrigine in association with other antidepressants can occur frequently in clinical practice, especially when depressive symptoms are resistant to monotherapy or are long-standing. The case we report highlights the likelihood of DILI with secondary liver damage due to the association between lamotrigine, quetiapine and sertraline through dose-dependent and not immune-mediated mechanisms.

Case presentation

We present the case of a young adult female with recurrent major depression that, after dose remodulation of antidepressant therapy with lamotrigine, quetiapine and sertraline, experienced abdominal pain with evidence of acute liver injury. Liver damage went into remission after antidepressant therapy was discontinued. DILI appears as a probable explanation for these findings (6 points in items for hepatocellular injury in the updated RUCAM score) caused by the interaction between these drugs.

Conclusions

This harmful effect is not yet well documented in the literature, and it seems to be due to a non-immune dose-dependent toxic effect. Caution is therefore warranted when prescribing the association of lamotrigine, quetiapine and sertraline.