Can sertraline (Zoloft) cause elevated liver enzymes (liver function tests) to increase?

From the Guidelines

Sertraline can cause elevated liver enzymes in some individuals, and it is essential to monitor liver function tests, especially in patients with pre-existing liver disease or those taking other medications that affect the liver. This antidepressant medication, commonly known by the brand name Zoloft, has been associated with mild to moderate elevations in liver function tests in approximately 1-3% of patients, as seen in the study by 1. These elevations typically occur within the first few weeks of treatment and are usually temporary and asymptomatic. However, in rare cases, sertraline can cause more significant liver injury.

Key Points to Consider

• The study by 1 provides guidance on the use of sertraline, including the recommended dose of 100 mg/day, which should be titrated according to symptoms and tolerance.
• It is crucial to monitor liver function tests regularly, especially in patients with pre-existing liver disease or those taking other medications that affect the liver, as recommended by 1.
• If you're taking sertraline and experience symptoms like yellowing of the skin or eyes, dark urine, upper right abdominal pain, or unusual fatigue, you should contact your healthcare provider immediately.
• The mechanism behind sertraline's effect on the liver isn't fully understood but may involve the metabolism of the drug by liver enzymes or an immune-mediated response, as suggested by 1.
• Despite this potential side effect, for most people, the benefits of sertraline for treating depression or anxiety outweigh this risk, and the medication can be used safely under the guidance of a healthcare provider.

From the FDA Drug Label

In man, asymptomatic elevations in serum transaminases (SGOT [or AST] and SGPT [or ALT]) have been reported infrequently (approximately 0. 8%) in association with sertraline hydrochloride administration. These hepatic enzyme elevations usually occurred within the first 1 to 9 weeks of drug treatment and promptly diminished upon drug discontinuation Liver and Biliary System Disorders-Rare: abnormal hepatic function ...elevated enzymes, increased bilirubin, hepatomegaly, hepatitis, jaundice, abdominal pain, vomiting, liver failure and death.

Sertraline (Zoloft) can cause elevated liver enzymes. Key points include:

• Asymptomatic elevations in serum transaminases (SGOT/AST and SGPT/ALT) have been reported infrequently (approximately 0.8%) in association with sertraline administration.
• These hepatic enzyme elevations usually occurred within the first 1 to 9 weeks of drug treatment and promptly diminished upon drug discontinuation.
• Rare cases of abnormal hepatic function, elevated enzymes, and other liver-related events have been reported 2.

From the Research

Sertraline and Elevated Liver Enzymes

• Sertraline, an SSRI, has been associated with elevated liver enzymes and hepatotoxicity in some cases 3, 4, 5, 6.
• A case report described a patient who developed acute hepatocellular liver injury after being treated with sertraline, with symptoms including elevated liver enzymes, jaundice, and gastrointestinal distress 3.
• Another study reported a case of severe drug-induced hepatitis in a patient receiving sertraline, highlighting the importance of discontinuing the drug in cases of suspected hepatotoxicity 4.
• Chronic sertraline exposure has been shown to induce morphometric changes, histological and histochemical alterations, and reduce the gene expression of drug metabolizing enzymes in animal studies 6.
• The onset of antidepressant-associated hepatotoxicity, including sertraline, can vary from 5 days to 3 years, and monitoring of liver function tests is crucial to detect early signs of liver dysfunction 5.

Mechanism and Risk Factors

• The mechanism of sertraline-induced hepatotoxicity is unknown, but it is thought to be idiosyncratic and may involve individual susceptibility and drug interactions 4, 5.
• Patients on chronic sertraline treatment may be at risk of hepatotoxicity, particularly those with underlying liver disease or taking concomitant medications that increase the risk of liver injury 5, 6.
• Asymptomatic elevations in liver enzymes have been reported in some cases, but severe hepatotoxicity is rare 4, 5.

Clinical Implications

• Sertraline should be discontinued in cases of suspected hepatotoxicity, and patients should be informed of the potential risk of liver injury 3, 4, 5.
• Monitoring of liver function tests is essential to detect early signs of liver dysfunction, particularly in patients on chronic sertraline treatment 5, 6.
• Further research is needed to explore the long-term safety and efficacy of sertraline, particularly in vulnerable populations 3, 6.