title: Drug dosage recommendations in patients with chronic liver disease.
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.
authors.affiliation: Department of Pharmacy. Hospital Universitari Son Espases. Palma de Mallorca-Illes Balears, Spain. leonord.perianez@ssib.es
authors.forename: Leonor
authors.initials: L
authors.lastname: Periáñez-Párraga
authors.forename: Iciar
authors.initials: I
authors.lastname: Martínez-López
authors.forename: Pere
authors.initials: P
authors.lastname: Ventayol-Bosch
authors.forename: Francesc
authors.initials: F
authors.lastname: Puigventós-Latorre
authors.forename: Olga
authors.initials: O
authors.lastname: Delgado-Sánchez
mesh_terms: D000890:Anti-Infective Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D002317:Cardiovascular Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D002908:Chronic Disease; D000075202:Contraindications; D004305:Dose-Response Relationship, Drug; D054796:Drug Dosage Calculations; D048550:Hepatic Insufficiency / Q000378:metabolism; D006801:Humans; D008099:Liver / Q000378:metabolism
chemical_list: D000890:Anti-Infective Agents; D000970:Antineoplastic Agents; D002317:Cardiovascular Agents