Wednesday, September 7, 2016

Psychotropic: Drug Induced Liver Injury


 Mood Stabilizers
  • Among mood stabilizers, carbamazepine and VPA are associated with the highest incidence of hepatotoxicity.
  • Although there are case reports of hepatotoxicity with oxcarbaze­pine, it may have a better liver safety profile than carbamazepine.
  • Hepatotoxicity with lamotrigine is rare, although fatal cases have been reported
Antipsychotics
  • When initiating an antipsychotic, a tem­porary, benign increase in liver enzymes can be expected, but typically discontinuation is unnecessary.
  • Phenothiazines in particular can cause increases in liver enzymes in 20% of patients.
  • Hepatotoxicity with benzodi­azepines is infrequent, with a few cases of cholestatic injury reported with diazepam, chlordiazepoxide, and flurazepam
SSRI
  • are relatively safe; incidents of hepatic injury are rare.
  • Among SSRIs, parox­etine is most frequently associated with hep­atotoxicity.
  • Abnormal liver function tests have been observed with fluoxetine (0.5% of long-term recipients) and other SSRIs
Antidepressants
  • Antidepressants with dual norepinephrine and serotonin reuptake inhibitor properties carry a higher risk of liver injury, especially duloxetine.
  • Hepatocellular, cholestatic, and mixed types of hepatotoxicity are associated with duloxetine-induced hepatotoxicity
Monitoring recommendations
  • Before prescribing potentially hepatotoxic medications, order baseline liver function tests.
  • During therapy, periodic liver func­tion monitoring is recommended. Elevated transaminase concentrations (>3 × the upper limit of normal), bilirubin (>2 × the upper limit of normal), and prolonged pro­thrombin times are indicators of hepatic injury.
  • Caution should be taken to prevent polypharmacy with multiple hepatotoxic medications and over-the-counter use of hepatotoxic drugs and supplements.
  • When choosing a psychotropic, take into account patient-specific factors, such as underlying liver disease and alcohol con­sumption.
  • Patients on potentially hepato­toxic medications should be counseled to recognize and report symptoms of liver dysfunction, including nausea, vomiting, jaundice, and lower-extremity edema
References:



1.      How to modify psychotropic therapy for patients who have liver dysfunction, Current Psychiatry Vol. 13, No. 12
2.      Antipsychotic Drugs – Prescribing & Monitoring in Adults Information for Primary Care
3.      MANAGEMENT OF MARKED LIVER ENZYME INCREASE DURING OLANZAPINE TREATMENT:A CASE REPORT AND REVIEW OF THE LITERATURE. Psychiatria Danubina, 2011; Vol. 23, Suppl. 1, pp 15–17

No comments:

Post a Comment

Note: Only a member of this blog may post a comment.