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???
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
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
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;
T3/T4. That should not bother your liver at all.
All of this is to be discussed with your doctor, of
Published March, 2002