Antidepressants- and antipsychotics-induced hepatotoxicity

Area of Science:

• Pharmacology
• Hepatology
• Toxicology

Background:

• Drug-induced liver injury (DILI) is a significant health concern with varied clinical outcomes, potentially leading to acute liver failure.
• Increased use of psychotropic medications, comorbidities, and polypharmacy in psychiatric patients contribute to a rise in psychotropic-induced DILI.
• Hepatotoxicity associated with antidepressants (ADs) and antipsychotics (APs) has garnered considerable attention over the past two decades.

Purpose of the Study:

• To comprehensively review and discuss the hepatotoxic effects of commonly prescribed ADs and APs.
• To classify, describe, and discuss the liver damage risks associated with specific ADs and APs, highlighting severe or life-threatening cases.
• To provide an overview of the mechanisms, including oxidative stress, inflammation, and steatosis, underlying AD- and AP-induced DILI.

Main Methods:

• Literature review of accumulated data on ADs and APs and their hepatotoxicity.
• Analysis of case reports, animal studies, and in vitro studies to understand the pathophysiology of DILI.
• Examination of drug-drug interactions resulting from ADs and APs affecting drug-metabolizing enzymes.

Main Results:

• Hepatotoxic effects of commonly prescribed ADs and APs are classified and described.
• Specific ADs and APs with a risk of causing liver damage, including severe DILI, are identified.
• Pathophysiological mechanisms such as hepatic oxidative stress, inflammation, steatosis, and drug-drug interactions are discussed.

Conclusions:

• Continuous data collection and critical review are essential for improved DILI diagnosis and risk assessment.
• Increased awareness of AD and AP hepatotoxicity is paramount for their safe prescription and optimal dosing.
• Understanding the mechanisms and risk factors for psychotropic-induced DILI is crucial for patient safety.