Psychotropic drugs and liver disease: A critical review of pharmacokinetics and liver toxicity

Table 4 Mood stabilizers and benzodiazepines and liver toxicity

	Epidemiology	Type of lesion	Mechanism
Antiepileptics
Carbamazepine	Transient ALT, AST, GGT elevations: 61% patients 1%-22%[3] DILI: 1%[170]	Hepatocellular, cholestatic	++Hypersensitivity -- Metabolic
Valproate	Transient ALT, AST elevations: 10%-15% patients[170] Hyperrubillirubinemia-44%[170] DILI: 3%-44%[173] Fatal DILI: 0.02% (0.2% children < 2a)[1]	Hepatocellular	Metabolic (Toxic metabolites through w-oxidation) Statosis
Lamotrigine	Transient ALT, AST elevations < 1% Rare hepatotoxicity[170] (4 severe DILI)[174]	Hepatocellular	Metabolic
Topiramate	Transient ALT, AST elevations < 1%[1] Rare hepatotoxicity (2 severe DILI)[174]	Hepatocellular	Metabolic
Gabapentine; pregabaline	Rare hepatotoxicity[1]	?	?
Benzodiazepines
Chlordiazepoxide, diazepam, flurazepam	Rare hepatotoxicity[171,172]	Cholestatic	Hypersensitivity
Litium
	Very rare hepatotoxicity[1]	?	?

DILI: Drug-induced liver injury; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGT: Gamma-glutamyl transferase.