From the Guidelines
Seroquel (quetiapine) can cause transaminitis, as evidenced by elevations in hepatic transaminase levels, although these elevations are often transient and generally resolve with cessation of the drug. The risk of liver damage associated with Seroquel treatment is a concern, and patients should be monitored accordingly. According to the practice parameter for the assessment and treatment of children and adolescents with schizophrenia 1, atypical agents like quetiapine may produce elevations in hepatic transaminase levels.
Some key points to consider when evaluating the risks of liver damage associated with Seroquel treatment include:
- Baseline liver functions should be checked prior to initiating treatment, with periodic monitoring during ongoing therapy 1
- The elevations in hepatic transaminase levels are often transient and generally resolve with cessation of the drug
- Rare cases of serious hepatotoxicity can develop, although the exact incidence is not well-established in the provided evidence
- Warning signs of liver problems include yellowing of the skin or eyes, dark urine, upper right abdominal pain, unusual fatigue, or nausea, and patients should seek immediate medical attention if these symptoms develop.
It is essential to weigh the benefits of Seroquel treatment against the potential risks of liver damage and to closely monitor patients for any signs of hepatotoxicity. By prioritizing patient safety and taking a proactive approach to monitoring liver function, healthcare providers can minimize the risks associated with Seroquel treatment and ensure the best possible outcomes for their patients.
From the FDA Drug Label
Since quetiapine is extensively metabolized by the liver, higher plasma levels are expected in patients with hepatic impairment. The FDA drug label does not answer the question.
From the Research
Risks of Liver Damage Associated with Seroquel (Quetiapine) Treatment
- The risk of liver damage associated with Seroquel (quetiapine) treatment is a concern, as with other antipsychotic medications 2.
- Studies have shown that antipsychotic-induced liver dysfunction is uncommon to rare, but can occur 2.
- Quetiapine is considered to pose a moderate risk of causing or worsening liver disease, compared to other antipsychotics such as chlorpromazine, clozapine, and olanzapine, which pose a higher risk 2.
- Transaminitis, or elevated liver enzymes, is the most common antipsychotic-induced liver injury, and is often mild and self-limiting 2.
- A review of liver function tests during treatment with atypical antipsychotic drugs, including quetiapine, found that asymptomatic increases in liver enzymes are common, but significant liver enzyme elevations are rare 3.
- Another study found that the overall incidence of transaminitis among patients receiving antipsychotic drugs, including quetiapine, was 17.04%, with no statistically significant difference between atypical and combined antipsychotic drugs 4.
- It is recommended to obtain baseline liver function tests before starting quetiapine and to monitor regularly for liver enzyme changes during therapy, especially in patients with risk factors for liver damage 5, 3.