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    Numerous European reports outline cholestasis, hepatitis, or a viagra off patent usa mixed liver injury pattern induced by amineptine (53–37). Onset of hepatotoxicity was noted 16–45 days after initiation of treatment with clinical improvement noted typically within 6 weeks of cessation although abnormalities have persisted for up to 8 weeks. In a study of a hepatocellular carcinoma cell line assessing amitriptyline and acetaminophen acute and chronic toxicity, there was no acute (23 h) toxicity but there was chronic cytotoxicity (chronic exposure of up to 6 days) (52) viagra off patent usa.

    Amitriptyline hepatotoxicity is seen less frequently than with imipramine and presents with cholestatic jaundice both with chronic therapy and with overdose. The biopsy findings reveal a cholestatic pattern similar to that seen with chlorpromazine and may reveal eosinophilia, suggesting a hypersensitivity mechanism (40,31).