Prescribing in hepatic impairment

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  • Created by: z
  • Created on: 22-02-16 21:37

Hepatic impairment

  • only occurs in sever disease as hepatic reserve islarge
  • PT does NOT reflect metabolic capacity (only synthetic function)
  • reduced function can results in:
    • hypoproteinaemia- reduced protein binding
      • complicates interpretation of phenytoin plasma conc b/c incr free drug
    • reduced clotting- incr sensitivity to warfarin, NSAIDs 
    • fluid overload (thus avoid drugs which exacerbate e.g. NSAIDs, corticosteroids)
    • biliary obstruction prevents excretion of some drugs (e.g. rifampicin) and action of others (e.g. colestyramine)
  • avoid drugs that precipitate hepatic encephalopathy
    • sedatives, diuretics (via hypokalaemia), constipators (opiates)
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