Schizophrenia Complicated by Chronic Hepatitis C Virus and Hepatic Encephalopathy

Treatment of Patients With Schizophrenia and Comorbid Chronic Hepatitis With Paliperidone: A Systematic Review

“…Many commonly used psychiatric drugs (including atypical antipsychotics) are titrated slowly and their doses are reduced as a result of poor hepatic functioning, which causes delays in achieving steady-state concentrations and prolonged elimination half-lives [5]. In the presence of liver disease, medications having substantial first-pass hepatic metabolism can result in high blood levels and side effects at regular dosages and should be carefully titrated [5]. The hepatic metabolism of paliperidone (an atypical antipsychotic) is rather modest [5].…”

“…Nearly two-thirds of newly identified cases of chronic liver disease in the general population are caused by hepatitis C virus (HCV) infection, either alone or in conjunction with alcohol-related liver disease [ 5 ]. Around 8.5% to 30% of patients with major mental illness have chronic HCV infection, which is an incidence that is 5-16 times higher than that of the general population [ 5 ]. Drug usage, especially injection drug use, is a significant HCV transmission route.…”

“…In samples of patients with major mental illness, rates of lifetime injectable drug use range from 5% to 35%, compared with 1.4% in the general population. Nearly half of the people with schizophrenia fulfill the criteria for a substance use disorder in their lifetime [ 5 ]. Patients with viral hepatitis and schizophrenia exhibit a considerably increased risk of severe hepatic outcomes compared to those without viral hepatitis since atypical antipsychotics can cause drug-induced liver injury [ 6 ].…”

“…Psychiatrists must take precautions to reduce any potential hepatic harm from certain drugs while treating patients with liver disease. Many commonly used psychiatric drugs (including atypical antipsychotics) are titrated slowly and their doses are reduced as a result of poor hepatic functioning, which causes delays in achieving steady-state concentrations and prolonged elimination half-lives [ 5 ].…”

“…In the presence of liver disease, medications having substantial first-pass hepatic metabolism can result in high blood levels and side effects at regular dosages and should be carefully titrated [ 5 ]. The hepatic metabolism of paliperidone (an atypical antipsychotic) is rather modest [ 5 ].…”