DUI and Liver Failure

In this case study, we reviewed the records of a man who was charged with DUI based on a positive opiate screen and symptoms of watery eyes, slow speech and lethargic demeanor. What we found was that he had started taking Wellbutrin just that morning and had a sudden onset of side effects due to his extensive liver failure and negligence by the healthcare provider prescribing the medication.

Case Summary

Mr. Smith had a significant and lengthy medical history that included Hepatitis C, cirrhosis, ITP, diabetes, peptic ulcer disease, depression, IV Drug abuse (heroin and cocaine), and prescription narcotic addiction. 

Mr. Smith’ history of liver disease was long-standing and had progressed over a period of two decades until he was finally at the point of end-stage liver disease. The liver’s main function is to regulate chemicals by breaking down harmful or toxic substances and excrete them. When the liver is damaged to any extent, these functions are compromised; the more damage the less the liver is able to function. Because of this lack of functionality, medications should be carefully considered to ensure the benefits outweigh the risks. 

At the time of his arrest, Mr. Smith was on Ibuprofen, HCTZ, Griseofulvin, Methadone, Diazepam, and Ambien. With the exception of HCTZ, these medications are metabolized through the liver, and are cautioned in hepatic impairment. Diazepam is contraindicated in patients with severe hepatic impairment. 

There are no interactions between Wellbutrin and the medications listed but the combination of adding Wellbutrin to an already overloaded liver would induce new side effects or potentiate any of the side effects listed under any of the medications he was on. The most likely side effects to be potentiated would be those that are listed under Wellbutrin as well as the other medications above: Those side effects are headache, dizziness, agitation, somnolence, memory decreased, hallucinations, concentration disturbance, and confusion.

On the day prior to his arrest, he went to see a psychiatrist and was placed on Wellbutrin. The doctor claimed to have considered the interactions of his medications and the hepatotoxic potential, yet prescribed the full 100mg dose instead of the recommended 75mg hepatic adjusted dose. She also failed to document the details of her conversation regarding consent. There is no evidence that she described the potential hazard of driving when first taking the medication or that she discussed the potential of the side effects being strong and rapid due to his liver failure. In fact, her notes indicate that she told Mr. Smith that the side effects would likely be mild; giving him a false sense of security in taking the new medication.

With his status of end-stage liver failure at the time of the arrest and the amount of medications that have CNS side effects, there is absolutely no way that anyone could predict the reaction by his body to yet one more medication that has significant side effects and is metabolized through the liver. The speed of onset of symptoms is likewise unpredictable. 

It is our opinion that the main cause of Mr. Smith’ behavior on the date of the arrest was an unexpected and sudden reaction to the addition of Wellbutrin to his prescription medication list. It is also our opinion that Mr. Smith was not fully educated or consented when the medication was prescribed; nor was the dose appropriate for his liver status. 

Works Cited

GlaxoSmithKline. (2010, May). Wellbutrin SR (bupropion hydrochloride) Prescribing Information. Greenville, NC: GlaxoSmithKline.

Tegeder, I., Lotsch, J., & Geisslinger, G. (1999). Pharmacokinetics of Opioids in Liver Disease. Clinical Pharmacokinetics, 37(1), 17-40.