Telles-Correia D, Barbosa A, Cortez-Pinto H, Campos C, Rocha NBF, Machado S. Psychotropic drugs and liver disease: A critical review of pharmacokinetics and liver toxicity. World J Gastrointest Pharmacol Ther 2017; 8(1): 26-38 [PMID: 28217372 DOI: 10.4292/wjgpt.v8.i1.26]
Corresponding Author of This Article
Dr. Diogo Telles-Correia, Faculty of Medicine, University of Lisbon, A.v. Padre Cruz, 1649-028 Lisbon, Portugal. tellesdiogo@gmail.com
Research Domain of This Article
Psychiatry
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Pharmacol Ther. Feb 6, 2017; 8(1): 26-38 Published online Feb 6, 2017. doi: 10.4292/wjgpt.v8.i1.26
Psychotropic drugs and liver disease: A critical review of pharmacokinetics and liver toxicity
Diogo Telles-Correia, António Barbosa, Helena Cortez-Pinto, Carlos Campos, Nuno B F Rocha, Sérgio Machado
Diogo Telles-Correia, António Barbosa, Helena Cortez-Pinto, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal
Carlos Campos, Sérgio Machado, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro 22290-140, Brazil
Nuno B F Rocha, School of Health Technologies, Polytechnic Institute of Porto, 4169-007, Porto, Portugal
Sérgio Machado, Postgraduate Program of Physical Activity Sciences, Salgado de Oliveira University, Niterói 24030-060, Brazil
Author contributions: Telles-Correia D, Barbosa A and Cortez-Pinto H contributed equally to this work; Telles-Correia D, Barbosa A, Cortez-Pinto H, Campos C, Rocha NBF and Machado S designed the study; Telles-Correia D, Barbosa A, Cortez-Pinto H and Rocha NBF wrote the paper.
Conflict-of-interest statement: The authors report no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Diogo Telles-Correia, Faculty of Medicine, University of Lisbon, A.v. Padre Cruz, 1649-028 Lisbon, Portugal. tellesdiogo@gmail.com
Telephone: +351-21-7985100 Fax: +351-21-7985112
Received: June 2, 2016 Peer-review started: June 3, 2016 First decision: September 9, 2016 Revised: November 2, 2016 Accepted: November 16, 2016 Article in press: November 17, 2016 Published online: February 6, 2017 Processing time: 134 Days and 6.7 Hours
Abstract
The liver is the organ by which the majority of substances are metabolized, including psychotropic drugs. There are several pharmacokinetic changes in end-stage liver disease that can interfere with the metabolization of psychotropic drugs. This fact is particularly true in drugs with extensive first-pass metabolism, highly protein bound drugs and drugs depending on phase I hepatic metabolic reactions. Psychopharmacological agents are also associated with a risk of hepatotoxicity. The evidence is insufficient for definite conclusions regarding the prevalence and severity of psychiatric drug-induced liver injury. High-risk psychotropics are not advised when there is pre-existing liver disease, and after starting a psychotropic agent in a patient with hepatic impairment, frequent liver function/lesion monitoring is advised. The authors carefully review the pharmacokinetic disturbances induced by end-stage liver disease and the potential of psychopharmacological agents for liver toxicity.
Core tip: The liver is the organ by which the majority of substances are metabolized, including psychotropic drugs. There are several pharmacokinetic changes in end-stage liver disease that can interfere with the metabolization of psychotropic drugs. The evidence is insufficient for definite conclusions regarding the prevalence and severity of psychiatric drug-induced liver injury. High-risk psychotropics are not advised when there is pre-existing liver disease, and after starting a psychotropic agent in a patient with hepatic impairment, frequent liver function/lesion monitoring is advised.
