What is the best antidepressant choice in hepatic dysfunction according to pharmacokinetics characteristics?

Many patients with liver failure use antidepressants extensively metabolized by the liver, making them more sensitive to adverse effects. We aimed to assess the pharmacokinetic characteristics of antidepressants to determine the most suitable drugs in liver failure. Books and databases were used for research. The descriptors used were antidepressants, liver failure, and pharmacokinetics. 18 antidepressants were revised. Among the classes of antidepressants are monoamine oxidase inhibitors (IMAOS), tricyclic antidepressants (ADTs), selective serotonin reuptake inhibitors (SSRIs), selective serotonin norepinephrine reuptake inhibitors (SNRI), antagonists of serotonin receptors (AR 5HT), and atypical antidepressants (ADA). All antidepressants show some degree of metabolization, with a small percentage of drugs excreted unchanged in the urine. The best antidepressant options for patients with liver failure is desvenlafaxine. This drug is an active metabolite of venlafaxine, with high percentage of unchanged metabolites eliminated in the urine. Desvenlafaxine present dose adjustments already established in these cases, and not showed liver abnormalities without increase in the level of transaminases. Along with efficacy, pharmacokinetic characteristics should be considered, especially metabolism, when prescribing antidepressants to patients with liver failure. Furthermore, close accompaniment is essential to avoid overload and liver damage.