Risperidon Kullanımına Bağlı Ortaya Çıkan Akut Toksik Hepatit: Olgu Sunumu

Yıl 2018, , 57 - 59, 30.05.2018

Nermin Gündüz , Celaleddin Turgut

https://doi.org/10.30934/kusbed.366173

Öz

İlaca bağlı karaciğer hasarı, hafif biyokimyasal değişikliklerden akut karaciğer yetmezliğine kadar uzanan klinik bir durumdur. Hepatik yan etkilerden sorumlu ilaçların %16’sı nöropsikiyatrik ilaçlardır. Risperidon psikotik bozuklar ve duygudurum bozuklarının tedavisinde sıklıkla kullanılan, serotonin tip 2 (5HT2) ve dopamin tip 2 (D2) almaçları üzerine antagonistik etki gösteren ikinci kuşak antipsikotiktir. Risperidon tedavisi sırasında KC enzimlerindeki yükselme prevalansı %01-1 olarak bildirilmiştir. Risperidon tedavisi alan hastalarda görülen hepatik yan etkilerin ciddiyeti ve sıklığı daha az olmasına rağmen risperidona bağlı nadiren karaciğer hasarları bildirilmiştir. Biz bu yazıda Bipolar Bozukluk tanılı genç bir kadın hastada risperidon tedavisi sonrası gelişen akut toksik hepatit vakasını paylaşmayı değer bulduk.

Anahtar Kelimeler

risperidon, toksik hepatit, atipik antipsikotik, hepatit

Acute Toxic Hepatitis Due To Risperidone Use: Case Report

Öz

Drug-induced liver damage is a clinical condition ranging from mild biochemical changes to acute liver failure. 16% of drugs responsible for hepatic side effects are neuropsychiatric drugs. Risperidone is a second-generation antipsychotic with antagonistic effect on serotonin type 2 (5HT2) and dopamine type 2 (D2) receptors, which is frequently used in the treatment of psychotic disorders and mood disorders. The prevalence of elevation of liver enzymes during risperidone treatment has been reported to be in the prevalence rates of 0.1-1 %. Although hepatic side effects observed in patients treated with risperidone are less severe and less frequent, liver damage due to risperidone is rarely reported. In this case report, we aimed to present acute toxic hepatitis after treatment with risperidone in a young female patient with Bipolar Disorder.

Anahtar Kelimeler

risperidone, toxic hepatitis, antipsychotic, hepatitis

Kaynakça

• Hussaini SH, Farrington EA. Idiosyncratic drug-induced liver injury: an overview. Expert Opin Drug Saf. 2007; 6:673–684.
• Andrade RJ, Lucena MI, Fernández MC, Pelaez G, Pachkoria K,García-Ruiz E, et al. Drug-induced liver injury: an analysis of 461 incidences submitted to the Spanish registry over a 10-year period. Gastroenterology. 2005; 129:512–521.
• Dumortier G, Cabaret W, Stamatiadis L, Saba G, Benadhira R, Rocamora JF, et al. Hepatic tolerance of atypical antipsychotic drugs. Encephale. 2002; 28:542- 551.
• Janssen PA, Niemegeers CJ, Awouters F, Schellekens KH, Megens AA, Meert TF. Pharmacology of risperidone (R64766), a new antipsychotic with serotonin- S2 and dopamine-D2 antagonistic properties. J Pharmacol Exp Ther. 1988; 244:685–693.
• Fang J, Bourin M, Baker GB. Metabolism of risperidone to 9-hydroxyrisperidone by human cytochromes P450 2D6 and 3A4. Naunyn Schmiedeberg’s Arch Pharmacol. 1999; 359:147–151.
• Mesotten F, Suy E, Pietquin M, Burton P, Heylen S, Gelders Y. Therapeutic effect and safety of increasing doses of risperidone (R 64766) in psychotic patients. Psychopharmacology (Berl). 1989; 99:445–449.
• Kumra S, Herion D, Jacobsen LK, Briguglia C, Grothe D. Case study: risperidone-induced hepatotoxicity in pediatric patients. J Am Acad Child Adolesc Psychiatry. 1997; 36:701–705.
• López-Torres E, Süveges Á, Peñas-LLedó EM, Doña A, Dorado P, LLerena A. et al. Liver enzyme abnormalities during antipsychotic treatment: a case report of risperidone-associated hepatotoxicity. Drug Metabol Drug Interact. 2014; 29(2):123-126.
• Naranjo CA, Busto U, Sellers EM et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981; 30:239-245.
• Kaplowitz N. Idiosyncratic drug hepatotoxicity. Nat Rev Drug Discov. 2005; 4:489–499.
• Dienstag JL, Isselbacher KJ. Acute hepatitis. Harrison´s principles of internal medicine. Isselbacher KJ, Braunwald E, Wilson JD (Ed), New York. McGraw- Hill, 1994; s. 1458-1477.
• Berecz R, Dorado P, De La Rubia A, Cáceres MC, Degrell I, LLerena A. The role of cytochrome P450 enzymes in the metabolism of risperidone and its clinical relevance for drug interactions. Curr Drug Targets. 2004; 5:573–579.
• Peppers MP. Benzodiazepines for alcohol withdrawal in the elderly and in patients with liver disease. Pharmacotherapy. 1996; 16(1):49–58.
• Coulouvrat C, Dondey-Nouvel L. Safety of amisulpride (Soliant): a review of 11 clinical studies. Int Clin Psychopharmacol. 1999; 14:209–218.
• Vieta E, Ros S, Goikolea JM, Benabarre A, Popova E, Comes M, et al. An openlabel study of amisulpride in the treatment of mania. J Clin Psychiatry. 2005; 66:575–578.