title: Antipsychotics and abnormal liver function tests:  systematic review.
abstract: OBJECTIVE
  Systematic assessment of the prevalence and pattern of liver function test (LFT) abnormalities associated with regular antipsychotics in adult humans and consideration of management of such abnormalities.
  
  
  METHODS
  Systematic search identifying cohort, cross-sectional or case studies/series, reporting LFT abnormalities in patients receiving regular antipsychotics. EMBASE, PsychINFO, and MEDLINE were searched for studies in English from record onset.
  
  
  METHODS
  Abstracts were independently screened for eligibility by 2 researchers. Ineligible studies included those that did not report LFT reference ranges, those that studied fewer than 10 patients on a given antipsychotic, and those studying children.
  
  
  METHODS
  Key variables in group studies were extracted. Case studies/series were examined for patient outcome.
  
  
  RESULTS
  Ten group studies and 91 case studies/series were eligible, although quality was poor. All groups receiving regular antipsychotics had a prevalence of LFT abnormalities greater than chance. The median percentage of patients with any abnormal LFT on any antipsychotic was 32%, with a range of 5% to 78%. The median percentage of patients with clinically significant elevations was 4%, with a range of 0% to 15%. Transaminases were most commonly elevated. Abnormalities were generally asymptomatic, arose within 6 weeks, and were either stably persistent or resolved with continued treatment. Case reports suggested that antipsychotics can be associated with severe hepatitis, fatal in a small minority of cases. Chlorpromazine is most commonly associated with acute liver injury.
  
  
  CONCLUSIONS
  The LFT abnormalities in patients receiving regular antipsychotics are common but generally mild and transient. Very rarely, a severe or fatal hepatic injury can emerge.
authors.affiliation: Division of Psychiatry, Kennedy Tower, Royal Infirmary of Edinburgh, Edinburgh, UK. Katherine.Marwick@cantab.net
authors.forename: Katie F M
authors.initials: KF
authors.lastname: Marwick
authors.forename: Mark
authors.initials: M
authors.lastname: Taylor
authors.forename: Simon W
authors.initials: SW
authors.lastname: Walker
mesh_terms: D000818:Animals; D014150:Antipsychotic Agents / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis* / Q000453:epidemiology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D006801:Humans; D008111:Liver Function Tests / Q000379:methods
chemical_list: D014150:Antipsychotic Agents