A 50 year old man is admitted to the ward with a long history of untreated psychosis. You note on his initial blood tests that he has significant renal failure. Which of the following should be avoided in this scenario?
Exam Question Jul 2014
Amisulpride is primarily eliminated via the renal route. For this reason it is best avoided in renal failure (as supported by the Maudsley Guidelines).
The other antipsychotics are extensively hepatically metabolised but reduced doses are still recommended in renal failure.
Exam Question Jul 2014
Amisulpride is primarily eliminated via the renal route. For this reason it is best avoided in renal failure (as supported by the Maudsley Guidelines).
The other antipsychotics are extensively hepatically metabolised but reduced doses are still recommended in renal failure.
Hepatic impairment
Patients with hepatic impairment may have:
- Reduced ability to metabolise (toxicity and enhanced dose related side effects)
- Reduced ability to synthesize plasma proteins (toxicity from high protein bound drugs)
- Reduced hepatic blood flow (elevated levels of drugs subject to first pass metabolism)
The following table (Maudsley Guidelines 2012) lists the drugs recommended in hepatic impairment:
| Drug Group | Recommendations |
|---|---|
| Antipsychotics | Haloperidol Amisulpride Sulpiride |
| Antidepressants | Imipramine Paroxetine Citalopram |
| Mood stabilisers | Lithium |
| Sedatives | Lorazepam Oxazepam Temazepam Zopliclone 3.75mg (with care) |
The Maudsley Prescribing Guidelines 11th Edition 2012.
