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Hepatotoxicity manifesting as liver injury: case report A 23-year-old man developed hepatotoxicity manifesting as liver injury during treatment with risperidone and paliperidone for schizophrenia. The man, who was diagnosed with schizophrenia, was admitted after an exacerbation of mental illness secondary to medication nonadherence. He was noted to have auditory halllucinations and delusions of persecution. His medical history was significant for cocaine and marijuana use. He was malnourished and noted to have lost 22 pounds till the time of admission. Further, he developed acute kidney injury due to dehydration secondary to poor oral intake. In order to avoid aggravation of the resolving kidney injury, he was initiated on risperidone, with slow dose titration from 1mg on day 1 to 4mg by day 8. However, on day 13 of risperidone initiation, his ALT and AST levels were found to be increased. Further laboratory examinations ruled out other causes of liver injury, and diagnosis of risperidone-induced liver injury was confirmed. The man’s therapy with risperidone was switched to oral paliperidone 6mg, and the liver enzymes started decreasing till day 5. As his psychiatric symptoms improved, he was administered IM long-acting injectable paliperidone [paliperidone palmitate] 234mg on day 16 following hospitalisation, and further continued receiving oral paliperidone. However, 10 days following IM paliperidone initiation (day 22 following hospitalisation), his AST and ALT levels began to trend upward. Hence, oral paliperidone was withdrawn and the second dose of IM paliperidone was withheld. His therapy was switched to haloperidol on day 26 following hospitalisation. Paliperidone-induced elevation in liver enzymes was suspected. Eventually, his liver function normalised 4 weeks following discontinuation of oral paliperidone. Khorassani F, et al. Risperidone- and paliperidone-induced hepatotoxicity: Case report and review of literature. American Journal of Health-System Pharmacy : 23 Jul 2020. 803497332 Available from: URL: http://doi.org/10.1093/ajhp/zxaa224

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Reactions 22 Aug 2020 No. 1818