Psychopharmacotherapy in Gastrointestinal and Liver Diseases

Abstract

The relation between psychopharmacological drugs and liver can be expressed mainly in three ways: 1) interactions with other pharmacological agents that are metabolized in the liver; 2) impact of psychopharmacological drugs in liver disease patients; 3)Direct liver toxicity induced by psychopharmacological drugs.

Almost all psychopharmacological drugs are metabolized in liver and CYP liver isoenzymes are responsible for metabolizing at least in part, more than 80% of all prescribed drugs. Some drugs induce these izoenzymes and others inhibit them.

Liver metabolization of psychopharmacological drugs might be impaired in liver disease patients. By the other hand blood proteins are reduced in liver disease, increasing the concentration of drugs that bind to proteins. Moreover liver disease patients sometimes have encephalopathy which can be aggravated by some drugs.

Monitoring liver function might be prudent following prescription of psychopharmacological drugs, especially if direct liver toxicity has been proven.

From research to practice we emphasize some important issues in managing everyday cases in the context consultation liaison psychiatry and general psychiatry practice.