Published: 1 June 2017

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Quetiapine — Delivering Hepatic Reactions?

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Prescriber Update 38(2): 18
June 2017

Key Messages

  • Hepatic adverse effects may occur with the use of quetiapine.
  • The most commonly reported hepatic adverse reaction is elevated liver enzymes.
  • Cases of hepatitis and hepatic failure have been reported.
  • Caution is advised in patients with known hepatic impairment, in patients who are being treated with potentially hepatotoxic medicines or if there are treatment-emergent signs or symptoms of hepatic impairment.


Healthcare professionals are reminded of the potential risk of hepatic adverse effects associated with the use of quetiapine, an atypical antipsychotic.

Quetiapine is extensively metabolised by the liver. Elevations in liver enzyme levels, particularly aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma-GT, may occur. Hepatitis has been reported rarely and hepatic failure very rarely during post-market monitoring. The exact mechanism of these hepatic reactions is currently unknown.

Therefore, precautions are recommended when using quetiapine:

  • in patients with pre-existing hepatic disorders
  • in patients who are also being treated with potentially hepatotoxic medicines
  • if signs or symptoms of hepatic impairment develop during treatment.

Dose adjustments or a reduced starting dose of quetiapine may be needed. Data sheets for quetiapine products are in the process of being updated with this information.

The Centre for Adverse Reactions Monitoring (CARM) has received 13 reports of hepatobiliary reactions with the use of quetiapine. The majority of these reports concerned increases in hepatic enzymes (also referred to as ‘hepatic function abnormal’ in the CARM database). There has also been one case of a hepatic cyst and one case of hepatic failure reported to CARM.

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