Table 5.

Pharmacokinetic changes caused by end-stage liver disease: Psychotropic drugs that require special attention

Avoid drugs with extensive first-pass metabolism	Avoid Tricyclic Antidepressants (first-pass metabolism 50%), venlafaxine, sertraline, bupropion, chlorpromazine, quetiapine
Avoid highly protein bound drugs	Avoid most psychotropic drugs (specially fluoxetine, aripiprazole and benzodiazepines). Except: Venlafaxine, lithium, topiramate, a gabapentin, a pregabalin, memantine
Avoid drugs depending on phase I hepatic metabolic reactions	Preferable: Lithium, gabapentin, topiramate, amisulpride (depending mainly on renal excretion) and some benzodiazepines (oxazepam, temazepam, lorazepam) that depend on phase II reaction or glucuronidation, which is preserved in cirrhosis