title: Management of marked liver enzyme increase during olanzapine treatment: a case report and review of the literature.
abstract: OBJECTIVE
  Atypical antipsychotics commonly cause isolated asymptomatic increase in the aminotransferase levels. Furthermore, the strategy in the choice of antipsychotic agent must take into account hepatic tolerance because of the non-negligible incidence of liver disorders among the psychiatric population. The aim of this article is to better understand the strategy to adopt during an increase of liver enzymes in a psychotic patient under atypical neuroleptic treatment.
  
  
  METHODS
  A clinical case is presented of a female patient treated for psychotic decompensation with increase of liver enzymes (Olanzapine). Her treatment was changed several times over a period of 7 years and laboratory investigations were conducted simultaneously.
  
  
  RESULTS
  It seems that the increase of liver enzymes is slightly more frequent with Clozapine and Olanzapine than Risperidone, Perazine and Haloperiol.
  
  
  CONCLUSIONS
  The different mechanisms of hepatotoxicity are unknown at present but it seems that the hypersensibility mechanism is likely to be dose dependent. During an increase of enzymes, it is important to combine a control of hepatic enzymes with a reduction of neuroleptic dosage. Discontinuation should be considered if a continued increase of enzymes above certain values is shown or if a clinical symptom appears. We note also that some risk factors were found, including geriatric or pedopsychiatric age, obesity, and association with active ingredients or addictive substances responsible for hepatic disorders.
authors: Université Catholique de Louvain, Clinic of Mont-Godinne, 5530 Yvoir, Belgium. pmanceaux@hotmail.fr
authors: Pauline
authors: P
authors: Manceaux
authors: Eric
authors: E
authors: Constant
authors: Nicolas
authors: N
authors: Zdanowicz
authors: Denis
authors: D
authors: Jacques
authors: Christing
authors: C
authors: Reynaert
mesh_terms: D000367:Age Factors; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001569:Benzodiazepines / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000201:enzymology*; D003024:Clozapine / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D005260:Female; D006220:Haloperidol / Q000009:adverse effects; D006801:Humans; D008099:Liver / Q000187:drug effects* / Q000201:enzymology*; D008875:Middle Aged; D000077152:Olanzapine; D010464:Perazine / Q000009:adverse effects; D012307:Risk Factors; D018967:Risperidone / Q000009:adverse effects; D000637:Transaminases / Q000187:drug effects
chemical_list: D014150:Antipsychotic Agents; D001569:Benzodiazepines; D010464:Perazine; D000637:Transaminases; D003024:Clozapine; D006220:Haloperidol; D018967:Risperidone; D000077152:Olanzapine