Meds Least Likely to Affect the Liver?
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Q:  Meds Least Likely to Affect the Liver?

I have been diagnosed since I was 14 years old. I am now 32 so I know some about the disorder. My question is that I have come up positive for Hepatitis C. I would like to know if there are any medications that are less likly to hurt my liver? I am on Wellbutrin right now. I used to be on 1500 mg of Lithium. I have pretty much taken all main drugs that have been perscribed for Bi-Polar. I would like to know if there is anything out there new that can lower the damage to my Liver???
Thank You

Dear Michelle -- 
As you have learned, Depakote and Tegretol are problems in this situation.  Anything that is metabolized in the liver will have to be watched carefully, but being metabolized there does not always mean "will hurt the liver".  So, by that logic, and using caution (checking liver enzymes early as the dose is increased from tiny amounts to start, and checking often thereafter for a while) you could try medications with less of a reputation for causing trouble.  You've probably heard about Neurontin, not even metabolized by the liver at all, just excreted by the kidney -- but that's not a good mood stabilizer at; in one study, placebo was better.  

So, ask your doctor about cautious trials of Trileptal, a Tegretol cousin that clearly causes less liver irritation.  And about lamotrigine, which is not routinely monitored for liver problems as are Depakote (by some doc's, anyway) and Tegretol (it's newer, and it may be that we just haven't gotten a good feel for how often it causes liver trouble).  These two, lamotrigine and Trileptal, clearly have excellent mood stabilizer properties.  Both can be combined with lithium, allowing a lower lithium dose (if you had trouble with it at higher doses).  

Then there's the less commonly used stuff.  Verapamil has some good evidence that it works as a mood stabilizer, although there are some studies that say it's no better than placebo either (it was originally a blood pressure medication, a "calcium channel blocker".  The guru of verapamil, Steve Dubovsky, a smart guy (and former chair of the department of Psychiatry at Colorado, no slouch) says you need to use the non-slow-release version, i.e. three times a day not once a day, for it work.  I recently have gone back to trying it, using that strategy, and sure enough, I've seen two people have clear, profound responses.  "Elevated liver enzymes" is on the list in the PDR, though, so you'd have to take that cautious approach.  It can alter lithium levels, too, so check that if you're using both. 

Finally, there's some very, very preliminary info' on thyroid, using two approaches: "hypermetabolic", per Whybrow et al; and T3/T4.  That should not bother your liver at all. 

All of this is to be discussed with your doctor, of course.

Dr. Phelps

Published March, 2002


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