CHLORPROMAZINE (THORAZINE) HEPATITIS: REPORT OF THREE CASES

Abstract

Three cases of hepatitis occurred in elderly individuals following ingestion of chlorpromazine (10-(gamma-dimethylaminopropyl)-2-chlorophenothiozine for about 2 weeks. Fever, malaise and anorexia were followed by the rapid development of obstructive jaundice. The hepatocellular function tests were normal, while the serum cholesterol and alkaline phosphatase were markedly elevated. The phosphatase remained high after the serum bilirubin and cholesterol had returned to normal..Liver biopsy showed cholestasis with plugging of the biliary canaliculi and varying degrees of cellular infiltration of the portal spaces. One patient displayed peripheral eosino-philia. One case illustrated the difficulty of establishing a differential diagnosis from surgical jaundice. Pain, and a tender mass in the right upper quadrant of the abdomen made exploratory laparotomy advisable even though chlorpromazine hepatitis was suspected. Because of the hazards involved and the seriousness of the hepatitis that may result, it is important that the use of chlorpromazine be strictly limited to those conditions were its benefits outweigh the risks.