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Cetirizine/olanzapine Hepatotoxicity: case report

A 15-year-old boy developed hepatotoxicity during treatment with cetirizine and olanzapine [indications not specified; dosages and routes not stated]. The boy was hospitalised due to disruptive mood dysregulation disorder, reactive attachment disorder, posttraumatic stress disorder and intellectual disability. He had previously received antipsychotics, stimulants and mood stabilisers [specific drug not stated], but his condition finally stabilised on lithium, clonidine and olanzapine. He had been also receiving treatment with cetirizine. On admission, he had a normal level of ALT and AST. One month after the initiation of olanzapine, his ALT and AST levels were found to be elevated. After ruling out other aetiologies, olanzapine and cetirizine were considered as the most probable causes of the elevated transaminases [not all durations of treatments to reactions onsets stated]. The boy’s treatment with cetirizine was discontinued, and vitamin E was prescribed to treat the elevated transaminases. Ten days later, his ALT and AST levels were found to be decreased. Vitamin E was discontinued to determine whether ongoing treatment was necessary. Cetirizine was not restarted. Seven days later, his ALT and AST levels were found to be increased again. Consequently, vitamin E was restarted and was part of his discharge medication regimen. Four weeks later, he continued to receive vitamin E and re-examination of his transaminases showed ALT at 20 U/L and AST at 24 U/L. Patel H, et al. Role of Vitamin E in Olanzapine-Induced Hepatotoxicity. Journal of Child and Adolescent Psychopharmacology : 2020. Available from: URL: https:// doi.org/10.1089/cap.2020.0042

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Reactions 5 Sep 2020 No. 1820