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Human Liver Microphysiological System for Assessing Drug-Induced Liver Toxicity In Vitro
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Antipsychotics and abnormal liver function tests: systematic review.

Katie F M Marwick1, Mark Taylor, Simon W Walker

  • 1Division of Psychiatry, Kennedy Tower, Royal Infirmary of Edinburgh, Edinburgh, UK. Katherine.Marwick@cantab.net

Clinical Neuropharmacology
|September 19, 2012
PubMed
Summary
This summary is machine-generated.

Liver function test abnormalities are common in patients taking antipsychotics but usually mild and temporary. Severe liver injury is rare but can be fatal, with chlorpromazine posing the highest risk.

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Area of Science:

  • Pharmacology
  • Hepatology
  • Psychiatry

Background:

  • Antipsychotic medications are widely prescribed for various psychiatric conditions.
  • Liver function test (LFT) abnormalities are a potential adverse effect of drug therapy.
  • Understanding the prevalence and pattern of LFT abnormalities associated with antipsychotics is crucial for patient safety.

Purpose of the Study:

  • To systematically assess the prevalence and pattern of liver function test abnormalities in adult patients regularly using antipsychotics.
  • To review the management of such abnormalities.
  • To identify specific antipsychotics associated with liver injury.

Main Methods:

  • A systematic literature search was conducted across EMBASE, PsychINFO, and MEDLINE for relevant studies.
  • Included were cohort, cross-sectional, and case studies/series reporting LFT abnormalities in patients on antipsychotics.
  • Studies were screened for eligibility, excluding those with missing LFT ranges, fewer than 10 patients, or pediatric populations.

Main Results:

  • The review identified 10 group studies and 91 case studies/series of variable quality.
  • A median of 32% of patients on antipsychotics experienced any LFT abnormality, with clinically significant elevations in a median of 4%.
  • Transaminase elevations were most common, typically asymptomatic, emerging within 6 weeks, and often resolving or persisting with continued treatment. Chlorpromazine was most frequently linked to acute liver injury.

Conclusions:

  • Liver function test abnormalities are frequent in patients using antipsychotics but are generally mild and transient.
  • While typically benign, antipsychotics can rarely cause severe or fatal hepatic injury.
  • Close monitoring for LFT abnormalities is warranted, especially with certain agents like chlorpromazine.