Table 1 Bupropion-induced hepatotoxicity case reports in the literature
From: Rapid bupropion-induced hepatotoxicity: a case report and review of the literature
First author, year [reference] | Dose | Duration of use (days) | Peak ALT/AST (U/L) | Peak bilirubin (mg/dl) | ANA | Outcome |
|---|---|---|---|---|---|---|
Oslin, 1993 [11] | 300 mg daily × 21 days, then 400 mg daily | 54 | 5.4 × ULN/7.8 × ULN | Not recorded | Not recorded | Complete resolution within 10 days of withdrawal of bupropion without needing steroids |
Hu, 2000 [8] | 200 mg daily | 42 | 6660/9040 | 3.8 (Normal) | Negative | Complete resolution within 10 days of withdrawal of bupropion without needing steroids |
Alvaro, 2001 [9] | 150 mg twice daily | 20 | 49 × ULN/68 × ULN | 38 (Raised) | Positive (1:80) | Complete resolution 50 days following withdrawal of bupropion, including 20 days of treatment with methylprednisolone (8 mg three times daily) |
Khoo, 2003 [12] | 150 mg daily | 10 | 674/429 | 84 (Raised) | Not recorded | Death 19 days after presentation with fulminant liver failure and DIC |
Humayun, 2007 [10] | 150 mg twice daily | 180 | 1459/1466 | 37 (Raised) | Positive (1:160) | Death owing to relapse despite initial improvement with prednisone (60 mg/day) |
Titos-Arcos, 2008 [13] | 150 mg daily × 15 days, then twice daily | 30 | 1405/473 | 12.14 (Raised) | Positive (1:80) | Complete resolution at 77 days after withdrawal of bupropion without needing steroids |
Alonso Rodríguez, 2010 [4] | 150 mg daily | Single dose | 1116/1837 | 8.7 (Normal) | Negative | Complete resolution at 20 days after cessation of bupropion without needing steroids |
Tang, 2015 [14] | 150 mg daily bupropion and 100 mg twice daily doxycycline | 14 | 896/1228 | 19.9 (Raised) | Negative but SMA-positive | Complete resolution after 67 days with prednisone tapering course starting at 40 mg/day |
Our patient | 150 mg daily × 3 days, then 150 mg twice daily × 3 days | 6 | 5007/4006 | 9 μmol/L (Normal) | Not recorded | Near-normalization within 23 days; was already on a weekly tapering course of prednisone for Crohn’s disease flare (30 mg/day at time of initial liver derangement) |