Which antipsychotic is contraindicated in severe hepatic impairment?

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

Answer: (A)

Severe hepatic impairment changes how antipsychotics are cleared because the liver is the main site of their metabolism. When liver function is severely reduced, drugs that rely on hepatic metabolism can accumulate in the body, leading to higher exposure and an increased risk of adverse effects.

Asenapine is contraindicated in severe hepatic impairment because it’s extensively metabolized by the liver, and there isn’t a proven safe dose for patients with severe liver dysfunction. Giving it could lead to markedly higher drug levels and a greater chance of unwanted effects such as excessive sedation, hypotension, or extrapyramidal symptoms.

The other options are not universally contraindicated in severe hepatic impairment; they may require caution or dose adjustments, but the restriction is specific to asenapine in this context.