Antidepressant Selection in Hepatic Impairment

Patient Assessment and Monitoring

• The Liver International guideline recommends documenting the severity of hepatic impairment (Child-Pugh classification if cirrhosis is present) before initiating any antidepressant in patients with known or suspected hepatic impairment 1
• For patients with severe hepatic impairment (Child-Pugh C), the Liver International guideline suggests exercising extreme caution and considering psychiatric consultation before initiating any antidepressant 1

Antidepressant Selection

• The Journal of the National Comprehensive Cancer Network guideline advises against using duloxetine entirely in hepatic impairment, as it should not be used in patients with any degree of hepatic insufficiency 2