The Effectiveness of Hepatoprotectants on Elevated Liver Enzyme Induced by Atypical Antipsychotics

Bahk, Won Myong; Chae, Jeong Ho; Jun, Tae Youn; Kim, Won

Abstract

OBJECTIVE
Atypical antipsychotics have been reported to induce the elevation of serum transaminase frequently in Korea, although most of them don't cause severe liver injury. Some hepatoprotectants are commonly prescribed in order to reduce the serum level of transaminase in patients with schizophrenia. We performed the chart review retrospectively for investigating the effect of two hepatoprotectants, biphenyl dimethyl dicarboxylate+garlic oil combination (BDD), and silymarin+silybin combination (SMR14) on the serum transaminase (AST/ALT) elevated by atypical antipsychotics. METHODS: We reviewed the clinical records of 54 schizophrenic patients who experienced the elevation of serum AST/ALT after the treatment with atypical antipsychotics. Patients with preexisting liver disease or elevated AST/ALT above in-house normal limitation at admission were excluded. We obtained the level of serum AST/ALT at the time of hepatoprotectants administration, 1 week, 2 weeks and 4 weeks after the administration. Repeated Analyses of variance were conducted in order to identify sequential change of serum AST/ALT level, and Fisher's exact test were performed to compare the number of patients whose AST/ALT levels were normalized after 4 weeks between two groups. RESULTS: 33 males and 21 females were included in this study and the mean age of those subjects was 36.28+/-10.92. Among all the patients, 35 were treated with BDD and 19 were treated with SMR14. After administration of hapatoprotectants, both serum AST and ALT level were significantly reduced during 4 weeks (F=10.56, p<0.001;F=17.92, p<0.001). BDD was superior to SMR14 in the number of patients whose ALT level reduced below in-house upper limitation after 4 weeks of treatment with hepatoprotectants (p=0.012), but there was no difference between BDD and SMR14 in aspect to AST level. CONCLUSION: Both hepatoprotectants, BDD and SMR14 were effective in reducing serum AST/ALT level which had been elevated by atypical antipsychotics. BDD was superior to SMR14 in normalizing serum ALT level within 4 weeks. Increased liver enzyme is prevalent in patients during the treatment with atypical antipsychotics. More research will be needed in this field.