How do you manage fatty liver disease in patients on olanzapine who are reluctant to change meds?

I have several forensic patients who have elevated LFTs and fatty liver on ultrasound, at least in part due to long-term olanzapine use. They are all reluctant to change meds, for fear of destabilizing and having to return to state forensic hospitals, where they have typically already spent more than a decade of their lives. Some are on metformin, but it doesn’t seem to help, at least not enough. For many, there are limitations on what food they have access to, so their diets are not ideal.

2 Answers

Mednet Member

Psychiatry · Boyle Health Services PLLC

Answered on · Updated on

I wonder if there are hepatologists available to consult with?

There is a new drug with a novel mechanism of action Rezdiffra (resmetirom) that is specifically studied/designed for MASH (NASH). I haven't seen it used yet in my patients, but I am fascinated by the mechanism of action. Will it have psychiatric side-effects since it modulates thyroid hormone receptor beta? Maybe since it's still on patent, there would be free programs for the drug to help with access to it?

Also, in this consultation with a hepatologist, I'd love to know if getting fibrosis scores on ultrasound liver can replace liver biopsy?

Also, would using one of the GLP-1s be a reasonable intervention? I understand in their ubiquitous effects, there are some signals about MA...

Join for free or sign in to see the full answer

Mednet Member

Psychiatry · Hope Services Llc

Answered on

I have never worked in forensic institutions. So my answer is a gut response to this question.

I would lower the dose of olanzapine (have a lot of respect for this medication), put the inmates on a diabetic diet (although they are not diabetic - I assume the forensic institutes follow this diet), and order increased activity. Let them walk 30-45 minutes per day by doctor’s order. Try this for six months and then check LFTs. If effective, continue the same regimen.

Join for free or sign in to see the full answer