From the Guidelines
Individuals with Primary Sclerosing Cholangitis (PSC) should not take Trintellix (vortioxetine) without consulting their healthcare provider, as liver impairment can affect the medication's processing and increase the risk of side effects. PSC affects liver function, and Trintellix is metabolized primarily by the liver. While there is no absolute contraindication specifically for PSC patients taking Trintellix, liver impairment can lead to higher blood levels of the drug and increased risk of side effects 1.
Key Considerations
- Liver function: PSC can impair liver function, affecting the metabolism of Trintellix and potentially leading to higher blood levels and increased side effects.
- Drug interactions: PSC patients often take multiple medications, so potential drug interactions should be evaluated.
- Alternative treatments: The decision to use Trintellix in someone with PSC should be individualized based on the severity of their liver disease, the need for antidepressant therapy, and consideration of alternative treatments that might have less impact on the liver.
Recommendations
- Consult with a healthcare provider before taking Trintellix.
- Monitor liver function closely during treatment.
- Evaluate potential drug interactions.
- Consider alternative treatments with less impact on the liver.
According to the EASL clinical practice guidelines on sclerosing cholangitis 1, managing complications of portal hypertension in PSC should follow Baveno/EASL guidelines for advanced chronic liver diseases. However, there is no specific guidance on the use of Trintellix in PSC patients. Therefore, the decision to use Trintellix should be made on a case-by-case basis, taking into account the individual's liver disease severity, need for antidepressant therapy, and potential alternative treatments.
From the Research
Primary Sclerosing Cholangitis (PSC) and Trintellix
- There is no direct evidence in the provided studies that suggests someone with PSC should not take Trintellix 2, 3, 4, 5, 6.
- The studies focus on the characteristics, diagnosis, and management of PSC, but do not mention Trintellix or its interaction with PSC.
- PSC is a chronic liver disease with no effective medical therapy, and management is mainly focused on treating symptoms and complications 2, 3, 4, 5, 6.
- Liver transplantation is currently the only life-extending therapeutic approach for eligible patients with end-stage PSC 2, 3, 4, 5, 6.
Treatment and Management of PSC
- Ursodeoxycholic acid is widely used to improve biochemical parameters of cholestasis, but its effectiveness is still unproven 4, 6.
- Endoscopic interventions, such as balloon dilatation and biopsy, are limited to clinically relevant strictures 6.
- Novel therapeutic strategies, including apical sodium-dependent bile acid transporter and ileal bile acid transporter inhibitors, are in various stages of development 6.