Which antipsychotic is contraindicated in severe hepatic impairment?

Which antipsychotic is contraindicated in severe hepatic impairment?

• A. Asenapine
• B. Clozapine
• C. Iloperidone
• D. Quetiapine

Answer: (A)

Severe liver impairment changes how antipsychotics are cleared from the body because the liver is the main site for their metabolism. When the liver isn’t functioning well, drugs can accumulate and cause toxicity or more pronounced side effects. Asenapine has a contraindication in severe hepatic impairment because its exposure increases markedly in this setting, making it unsafe to use. In contrast, other antipsychotics may be used with caution or require dose adjustments rather than being completely avoided in severe liver disease, so they are not outright contraindicated. This is why asenapine stands out as the one that should not be used in severe hepatic impairment.

Severe liver impairment changes how antipsychotics are cleared from the body because the liver is the main site for their metabolism. When the liver isn’t functioning well, drugs can accumulate and cause toxicity or more pronounced side effects. Asenapine has a contraindication in severe hepatic impairment because its exposure increases markedly in this setting, making it unsafe to use. In contrast, other antipsychotics may be used with caution or require dose adjustments rather than being completely avoided in severe liver disease, so they are not outright contraindicated. This is why asenapine stands out as the one that should not be used in severe hepatic impairment.