Drug dosage recommendations in patients with chronic liver disease

Rev Esp Enferm Dig. 2012 Apr;104(4):165-84. doi: 10.4321/s1130-01082012000400002.

Abstract

Chronic liver diseases (CLD) alter the kinetics of drugs. Despite dosage adjustment is based on Child-Pugh scores, there are no available recommendations and/or algorithms of reference to facilitate dosage regimens. A literature review about dose adjustment of the drugs from the hospital guide -which are included in the list of the WHO recommended drugs to be avoided or used with caution in patients with liver disease- was carried out. The therapeutic novelties from the last few years were also included. In order to do so, the summary of product characteristics (SPC), the database DrugDex-Micromedex, the WHO recommendations and the review articles from the last 10 years in Medline were reviewed. Moreover, the kinetic parameters of each drug were calculated with the aim of establishing a theoretical recommendation based on the proposal of Delcò and Huet. Recommendations for 186 drugs are presented according to the SPC (49.5%), DrugDex-Micromedex (26.3%) and WHO (18.8%) indications; six recommendations were based on specific publications; the theoretical recommendation based on pharmacokinetic parameters was proposed in four drugs. The final recommendations for clinical management were: dosage modification (26.9%), hepatic/analytical monitoring of the patient (8.6%), contraindication (18.8%), use with caution (19.3%) and no adjustment required (26.3%). In this review, specific recommendations for the practical management of patients with chronic liver disease are presented. It has been elaborated through a synthesis of the published bibliography and completed by following a theoretical methodology.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anti-Infective Agents / administration & dosage*
  • Anti-Infective Agents / pharmacokinetics
  • Antineoplastic Agents / administration & dosage*
  • Antineoplastic Agents / pharmacokinetics
  • Cardiovascular Agents / administration & dosage*
  • Cardiovascular Agents / pharmacokinetics
  • Chronic Disease
  • Contraindications
  • Dose-Response Relationship, Drug
  • Drug Dosage Calculations
  • Hepatic Insufficiency* / metabolism
  • Humans
  • Liver / metabolism

Substances

  • Anti-Infective Agents
  • Antineoplastic Agents
  • Cardiovascular Agents