title: Psychotropic drugs and liver disease: A critical review of pharmacokinetics and liver toxicity.
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.
authors.affiliation: Diogo Telles-Correia, António Barbosa, Helena Cortez-Pinto, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal.
authors.forename: Diogo
authors.initials: D
authors.lastname: Telles-Correia
authors.affiliation: Diogo Telles-Correia, António Barbosa, Helena Cortez-Pinto, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal.
authors.forename: António
authors.initials: A
authors.lastname: Barbosa
authors.affiliation: Diogo Telles-Correia, António Barbosa, Helena Cortez-Pinto, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal.
authors.forename: Helena
authors.initials: H
authors.lastname: Cortez-Pinto
authors.affiliation: Diogo Telles-Correia, António Barbosa, Helena Cortez-Pinto, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal.
authors.forename: Carlos
authors.initials: C
authors.lastname: Campos
authors.affiliation: Diogo Telles-Correia, António Barbosa, Helena Cortez-Pinto, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal.
authors.forename: Nuno B F
authors.initials: NB
authors.lastname: Rocha
authors.affiliation: Diogo Telles-Correia, António Barbosa, Helena Cortez-Pinto, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal.
authors.forename: Sérgio
authors.initials: S
authors.lastname: Machado
keywords: Hepatic disease; Liver; Pharmacokinetics; Psychotropic drugs; Toxicity