|
Q: Could These Meds Cause Bile Duct Problems
My daughter has bipolar disorder and PCOS and thyroid disorder.
Last year she had a serious gall bladder attack and they removed her gall
bladder. They found a very large gall stone. A year later (March
2004) she experienced gall bladder pain and elevated liver enzymes. They
did a MRI and said they thought there might be problem with her commom duct.
Last night she was admitted again with severe "gall bladder" pain. Liver
enzymes are ok. The gastro doctor on call said it was her psychiatric meds
causing the problem with her duct and she needed to switch to tricyclics.
She takes depakote, topamax and seroquel for bipolar. She also takes
glucophage, birth control and thyroid medicine. Could her meds be causing
her duct problems?
Dear Pat --
Haven't heard of any of those three associated with bile duct problems (depakote,
topamax and seroquel ). So, searching PUB MED on each one: (e.g for Depakote,
enter valproate bile duct; then topiramate bile duct and
quetiapine bile duct )
Depakote: we know valproate can sometimes cause liver problems. Apparently in
some cases this includes "bile duct proliferation"
Scheffner
(careful with over interpreting this reference: this should not be interpreted as
indicating that valproate is any more dangerous than you thought before, despite
this report of 18 deaths; we have to keep these in context, e.g. the thousands
more deaths untreated bipolar disorder can cause. However, I'd like to promote
the idea that we should cite sources for anything we doctors say, including
providing those sources to the patients who ask -- as below*) but usually the
problem is more with the liver cells than the duct cells.
Topomax, Seroquel: no results.
This is a crude search. Trying the same approach again using cholelithiasis
(stones), no results.
I guess the next step would be to politely, and with a thank you for pointing
out this problem, ask the on-call doc' for a reference* regarding this problem
(which one of the three was he concerned about, for example?) As a GI doc I
guess we can excuse the fact that he (it was a he, right? just guessing...)
doesn't know that tricyclics would be a really bad idea as a "substitute" for
"her psychiatric med's".
Dr. Phelps
Published September, 2004
|