Prescribing in liver disease

  • Use hepatotoxic drugs with caution.
  • Aim to use short acting drugs.
  • Start with a small dose and increase slowly or as required.
  • Monitor response to titrations closely (for example analgesic control).
  • Consider overall goals of care, mindful of prognosis.

 

Specific considerations

 

  • Hepatic encephalopathy:be aware of increased sensitivity to sedatives, hypnotics and central nervous system depressants; use caution when prescribing constipating agents.
  • Be vigilant for concurrent renal impairment and prescribe accordingly.
  • In patients with a low albumin: be mindful of prescribing drugs that are highly protein bound (such as warfarin, anticoagulants, oral antidiabetics).