You are asked to review a man on a hospital ward with hemochromatosis who has been observed to be low in mood. On review of his blood results you note significant hepatic impairment. You history and examination confirms that he is depressed. Which of the following medications would be indicated to manage his depression?
Haemochromatosis is an inherited disorder in which iron levels in the body slowly build up over many years. If left untreated, the extra iron is deposited in the body, usually around organs, such as the heart and liver and can lead to both liver and heart failure. Once diagnosed, hemochromatosis is treated by phlebotomy to rid the body of excess iron and to maintain normal iron stores.
Haemochromatosis is an inherited disorder in which iron levels in the body slowly build up over many years. If left untreated, the extra iron is deposited in the body, usually around organs, such as the heart and liver and can lead to both liver and heart failure. Once diagnosed, hemochromatosis is treated by phlebotomy to rid the body of excess iron and to maintain normal iron stores.
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.
