Anti-Dementia Drugs and Hepatotoxicity–Report of Two Cases

Two patients with Alzheimer's disease who developed hepatitis caused by anti-dementia drugs are presented. Case 1: An 84-year-old-woman was referred to our hospital with profound jaundice. The levels of liver enzymes and jaundice decreased after the cessation of memantine and yokukansan (herbal medicine approved for dementia in Japan). Case 2: An 82-year-old-man was referred because of elevated transaminases. Liver biopsy showed central necrosis typical for drug-induced liver injury. The levels of transaminases decreased after withdrawal of rivastigmine transdermal patch treatment. Anti-dementia drugs have been safely used in terms of hepatotoxicity. However, some cases might be missed because of the difficulty in recognizing signs and symptoms in elderly and dementia patients.