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Author: Admin | 2025-04-28
US Pharm. 2020;45(12)9-12. ABSTRACT: Cirrhosis results when chronic insults to the liver finally cause irreversible fibrosis. Because the liver is the primary site of drug metabolism, the pharmacokinetic profiles of drugs can be altered in patients with cirrhosis. Approximately 30% of patients with cirrhosis experience adverse drug reactions. While scoring systems may assist in classifying the severity of liver disease, no test can determine drug dosing in patients with cirrhosis. Furthermore, no evidence-based guidelines exist for the use of medications in patients with liver cirrhosis. Pharmacists can play a key role in modifying medications based on liver function to ensure safe medication use in patients with cirrhosis. Approximately 4.5 million Americans have been diagnosed with chronic liver disease.1 Chronic liver diseases include alcoholic liver disease, chronic viral hepatitis, nonalcoholic fatty liver disease, and hemochromatosis. Chronic liver disease usually progresses to cirrhosis. In the United States, cirrhosis affects about 1.8% of the adult population.1 Cirrhosis is the leading cause of liver-related deaths.1,2 Risk factors for the development of cirrhosis include hypertension, hyperlipidemia, diabetes, obesity, moderate alcohol consumption, chronic hepatitis B or C, male sex, and age above 50 years.2-4 Cirrhosis is characterized by fibrosis and nodule formation from liver insults and is classified as compensated or decompensated depending on the degree of liver distortion. Compensated cirrhosis patients are asymptomatic and the liver is still able to perform basic functions. Decompensated cirrhosis typically follows compensated cirrhosis. Patients with decompensated cirrhosis often exhibit serious symptoms and complications such as ascites, bacterial infections, variceal bleeding, portal hypertension, or encephalopathy. Prognosis and survival are markedly better in patients with compensated cirrhosis than in those with decompensated disease.5 Since the liver is the primary site of drug metabolism, the disposition and clinical effects of drugs can be altered in patients with cirrhosis. Risk factors for impaired drug effects include altered hepatic blood flow, altered drug pharmacokinetics, reduced drug-binding proteins, and severity of liver dysfunction. Nearly 30% of patients with cirrhosis suffer adverse drug reactions or hepatoxicity if these risk factors are not considered or monitored closely.6 This is because 20% of the drugs in patients with liver cirrhosis are dosed incorrectly.6 Patients with compensated cirrhosis have a lesser extent of impaired drug metabolism compared with patients with decompensated cirrhosis. Pharmacists have a responsibility to ensure safe medication use in patients with cirrhosis. This article will provide pharmacists a practical overview of the impact of cirrhosis on
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