From the Research
Psychiatric Medications in Patients with Liver Disease due to Hepatitis B (HBV) Infection
- The liver plays a crucial role in metabolizing psychotropic drugs, and patients with liver disease due to HBV infection require careful consideration when prescribing psychiatric medications 1.
- Certain psychiatric medications, such as neuroleptics, mood stabilizers, and some antidepressants, are associated with drug-induced liver injury (DILI) and should be avoided in patients with advanced chronic liver diseases 2.
- High-risk psychotropics are not advised in patients with pre-existing liver disease, and frequent liver function monitoring is recommended after starting a psychotropic agent in a patient with hepatic impairment 1.
- Short-acting benzodiazepines are preferred over their alternatives when treating alcohol withdrawal syndrome (AWS) in patients with alcohol liver disease (ALD) 3.
- All anticonvulsants can be used in patients with decompensated liver disease with caution, although newer generation antiepileptic agents should be first line 3.
- Propofol is favored over benzodiazepines or opioids in the case of decompensated cirrhosis 3.
Considerations for Prescribing Psychiatric Medications
- Protein binding, metabolism, bioavailability, extraction ratios, excretion route, and half-life must be taken into consideration when prescribing medication to patients with liver disease due to HBV infection 3.
- Frequently repeating liver panels is necessary to monitor the patient's liver function 3.
- An integrated perspective of the medical case, considering the underlying illness and possible drug interactions, is crucial in treating psychiatric disorders in patients with liver disease due to HBV infection 3.