Cylert and Liver disease

In general, CNS stimulants are extensively metabolized by the liver. Their plasma clearance may be decreased and their half-life prolonged in patients with impaired hepatic function. Therapy with CNS stimulants should be administered cautiously in patients with moderate to severe liver disease, and the dosage should be adjusted accordingly. Additionally, postmarketing reports have shown that atomoxetine can cause severe liver injury. Laboratory testing should be done at the first sign or symptom of liver dysfunction (jaundice, dark urine, upper quadrant tenderness) and treatment should be discontinued in patients with evidence of liver injury.

The use of pemoline is contraindicated in patients with impaired hepatic function or abnormal liver function tests. Hepatotoxicity ranging from asymptomatic, reversible elevations in serum transaminases to hepatitis, jaundice, and rare cases of acute, life-threatening hepatic failure has been reported in patients treated with pemoline. The earliest onset of hepatic abnormalities occurred 6 months after initiation of medication. Therapy with pemoline should be administered cautiously in patients with a history of liver disease and/or heavy alcohol use. Liver function tests should be performed prior to and periodically during therapy, although it is unclear if they are predictive of pemoline-induced liver injury. Pemoline therapy should be withdrawn in patients who develop signs and symptoms suggestive of hepatotoxicity.