Hepatotoxicity Associated with Venlafaxine

Characterization of Hepatotoxicity

• The American College of Physicians suggests that venlafaxine-induced hepatotoxicity is a rare idiossincratic reaction without a clear dose-dependent relationship, based on weak evidence from observational studies 1, 2
• The American Gastroenterological Association does not require routine monitoring of transaminases in patients without risk factors, unlike other antidepressants such as nefazodone 3

Clinical Management

• The American Academy of Child and Adolescent Psychiatry recommends immediate discontinuation of venlafaxine upon signs of clinically significant hepatic dysfunction, with a slow taper to avoid discontinuation syndrome 4
• The American Academy of Child and Adolescent Psychiatry and other guidelines suggest suspending venlafaxine immediately with a slow taper to avoid discontinuation syndrome, upon identification of hepatotoxicity 4, 5