You are asked to review a patient on the gastroenterology ward who has started hearing voices. They have abnormal LFTs and a history of heavy alcohol use. Which of the following antipsychotics would you suggest?
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
