Hepatotoxicity of Psychotropic Drugs and Drugs of Abuse

I. INTRODUCTION Many psychoactive medications are highly fat-soluble and require hepatic metabolism. Therefore, not surprisingly, metabolism of many these drugs is affected by hepatic dysfunction and, further, their metabolites may have hepatotoxic effects. The majority of psychotropic drugs cause a hepatitis-like illness but some may lead to a cholestatic picture. In fact, chlorpromazine’s mechanism of cholestatic injury represents one of the most elegantly elucidated examples of drug-induced liver injury. A few drugs cause a mixed hepatocellular-cholestatic form of injury (Fig. 1).