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Prescribing in Liver Disease (Cautions in Hepatic Impairment…
Prescribing in Liver Disease
Cautions in Hepatic Impairment
Hypoalbuminaemia
↑ proportion of free drug
Phenytoin, CBZ
Prednisolone
Diazepam
Tolbutamide
↓ Synthesis of Clotting Factors
Warfarin
Abx (kill GI microflora)
↓ First Pass Metabolism
Opiates
Phenothiazines
Imipramine
↓ α1-acidic Glycoprotein
Binds basic drugs
e.g. chlorpromazine, quinidine, imipramine
Encephalopathy
Sedatives / Opiates: may → coma
Caution with drugs that may → constipation
Anxiolytics: temazepam safest (short t½)
Avoid chlormethiazole
Anti-depressants: TCAs safest (but ↓ dose)
Avoid MOAIs
Hepatorenal Syndrome
Tx
Withdraw nephrotoxic drugs
Modify doses of renally-excreted drugs
Hepatotoxicity
Cholestatic
Clavulanic acid: may be delayed
Fluclox: may be delayed
Erythromycin
Sulfonylureas (glibenclamide)
OCP
Tricyclics
Chlorpromazine, prochlorperazine
Hepatocellular Damage
Paracetamol
Valproate, phenytoin, CBZ
RMP, INH, PZA
Halothane
Methotrexate
Statins
Chronic Hepatitis
INH
Methyldopa
Gallstones
OCP