Jaundice thioridazine

The majority of cases reported in the literature have occurred with CPZ and rarely with other agents such as promazine, thioridazine, mepazine, prochlorperazine, fluphenazine, and triflupromazine. There is no convincing evidence that haloperidol or other nonphenothiazine agents produce this type of jaundice. It is occasionally useful to obtain baseline liver function tests on patients with increased susceptibility (e.g., prior history of hepatitis) in the unlikely event that jaundice may develop. Routine serial liver function tests have never proven useful or necessary. The offending drug should be discontinued if a patient develops jaundice, but the value of this practice is also unproven, because many patients have been maintained on CPZ throughout an episode of jaundice without adverse consequences ( 509). 

Undesirable hypotension occurred in two patients taking chlorpromazine or trifluoperazine with trazodone. Thioridazine causes a moderate rise in trazodone plasma levels. A fatal case of jaundice and hepatic encephalopathy has been reported with the use of trifluoperazine, thioridazine and trazodone. 

A study, undertaken to confirm the involvement of the cytochrome P450 isoenzyme CYT2D6 in the metabolism of trazodone, found that when 11 depressed patients were given trazodone 150 to 300 mg at bedtime for 18 weeks, and then with thioridazine 20 mg twice daily for one week, the plasma levels of the trazodone and its active metabolite, /w-chlorophenyl-piperazine, rose by 36% and 54%, respectively. No adverse reactions were described. In contrast, a case of fatal hepatic necrosis with cholestasis has been attributed to the concurrent use of trazodone and phenothiazines. A 72-year-old woman taking trifluoperazine, trazodone and lithium carbonate developed an elevated alanine aminotransferase level. Trifluoperazine was replaced with thioridazine, but 9 weeks later she became jaundiced and developed hepatic encephalopathy, and died 6 weeks after the onset of jaundice. The authors consider that the combination of the phenothiazines and trazodone were the cause of her hepatic necrosis both phenothiazines and trazodone have been reported to individually cause hepatic adverse effects. ... 

Although hepatic complications of thioridazine treatment are rare, cases occasionally occur. The case is reported of a 58-year-old patient who became jaundiced and showed abnormal liver function tests after taking thioridazine for 15 months. The jaundice cleared and the liver function tests returned to normal when treatment was stopped. Seventeen years previously the patient had become jaundiced when taking chlorproma-zine. The authors warn of the dangers of giving phenothiazines to patients who have previously shown adverse reactions to them (50 ). 

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