Quetiapine and LFTs

 Q; 82 years old male was admitted to ICU with septic shock, and is now recovering. Pressors are off and patient is extubated. Patient has been started on Quetiapine for mild delirium 4 days ago. Mild elevation of transaminases and bilirubin noted. Quetiapine should be continued as far as QTc interval is normal on EKG? 

A) True 

B) False

Answer: B

Hepatotoxicity from quetiapine can be fatal. It is as important to follow as QTc interval. Although it is a rare complication but any deterioration in Liver Function Test (LFT) should be taken seriously. It can occur with a regular dose of 25 mg and with a short term use of 7-10 days 

The benign side-effects from quetiapine are dry mouth, sedation, somnolence, dizziness, fatigue, and constipation.

#toxicity

#hepatology

#pharmacology

References:

1. Shpaner A, Li W, Ankoma-Sey V, Botero RC. Drug-induced liver injury: hepatotoxicity of quetiapine revisited. Eur J Gastroenterol Hepatol 2008; 20:1106. 

2. El Hajj I, Sharara AI, Rockey DC. Subfulminant liver failure associated with quetiapine. Eur J Gastroenterol Hepatol 2004; 16:1415. 

3. Naharci MI, Karadurmus N, Demir O, et al. Fatal hepatotoxicity in an elderly patient receiving low-dose quetiapine. Am J Psychiatry 2011; 168:212.