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Liver is the key organ to metabolize various drugs and nutrients. It is very important to know in clinical perspective that liver dysfunction leads to change the level of the drugs. Toxic materials due to liver dysfunction cause several neurological and psychiatric symptoms such as fatigue, change o...

Liver is the key organ to metabolize various drugs and nutrients. It is very important to know in clinical perspective that liver dysfunction leads to change the level of the drugs. Toxic materials due to liver dysfunction cause several neurological and psychiatric symptoms such as fatigue, change of mood & personality, and memory disturbances. Patients with liver diseases also have comorbid psychiatric disorders such as depressive disorders, anxiety disorders, alcohol and other substance use disorders. The purpose of this article is to review about the issues of psychopharmacotherapy of patients with liver diseases. The metabolic process of the drugs in liver are divided into phase I and phase Ⅱ metabolism. The clearance of the drugs depend on the rate of delivery of the drugs to hepatic enzymes, and the intrinsic capacity of hepatic enzymes. There can be changed of absorption, distribution, metabolism, and excretion of the drugs when we use psychiatric drugs in patients with liver diseases. Because the most psychiatric drugs are primarily metabolized in liver, liver dysfunction can reduce the clearance of the drugs, and change the blood level of the drugs. The issues of each psychiatric drugs are discussed in this article. Psychiatrists should be cautious to develop adverse effects of the psychiatric drugs, and need to monitor carefully. The initial doses of psychiatric drugs in patients with liver diseases should be reduced and titrated more slowly than medically healthy patients. But the interactions of most psychiatric drugs in patients with liver diseases are not clinically significant.

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