From the FDA Drug Label
Asymptomatic, transient, and reversible elevations in serum transaminases (primarily ALT) have been reported In schizophrenia trials in adults, the proportions of patients with transaminase elevations of >3 times the upper limits of the normal reference range in a pool of 3- to 6-week placebo-controlled trials were approximately 6% (29/483) for quetiapine compared to 1% (3/194) for placebo ALT Increased 5%
Quetiapine can cause elevation of ALT. The incidence of ALT elevation was 5% in patients treated with quetiapine, which is higher than the incidence in placebo-treated patients. However, these elevations were usually asymptomatic, transient, and reversible. 1
From the Research
Yes, quetiapine (Seroquel) and other psychiatric medications can cause isolated elevation of Alanine Transaminase (ALT). According to a study published in 2007 2, quetiapine has been associated with liver enzyme abnormalities in approximately 1-2% of patients, typically occurring within the first few weeks of treatment. Other psychiatric medications that may cause ALT elevation include valproate, carbamazepine, and certain antipsychotics like olanzapine and clozapine. These elevations are often mild to moderate (less than 3 times the upper limit of normal) and asymptomatic, frequently resolving without discontinuation of the medication.
Key Points to Consider
- Regular monitoring of liver function tests is recommended, particularly during the initial months of treatment 2.
- If ALT levels exceed 3 times the upper limit of normal, or if symptoms of liver dysfunction develop (such as jaundice, fatigue, abdominal pain, or nausea), the medication should be reassessed.
- The mechanism behind these elevations varies by drug class but often involves either direct hepatocellular injury or metabolic stress on the liver.
- Patients with pre-existing liver disease, those taking multiple hepatotoxic medications, or those who consume alcohol regularly may be at higher risk for developing clinically significant elevations.
Relevant Studies
- A study published in 2007 2 found that 27.2% of patients showed asymptomatic increases in ALT, AST, GGT, and serum bilirubin levels in the first month of treatment with atypical antipsychotic drugs, including quetiapine.
- Another study published in 2014 3 compared the metabolic effects of aripiprazole, quetiapine, and ziprasidone in first-episode psychosis patients, but did not specifically address ALT elevation.
- A meta-analysis published in 2012 4 compared the tolerability profile of quetiapine, risperidone, aripiprazole, and ziprasidone in schizophrenia and affective disorders, but did not focus on liver enzyme abnormalities.
Clinical Implications
- Regular monitoring of liver function tests is crucial to detect potential liver enzyme abnormalities early on, particularly in patients with risk factors for liver disease.
- Clinicians should be aware of the potential for ALT elevation with quetiapine and other psychiatric medications, and adjust treatment plans accordingly to minimize the risk of liver injury.