title: The pharmacotherapy of cirrhosis: concerns and proposed investigations and solutions.
abstract: OBJECTIVE
  The presence of cirrhosis has a multifaceted impact on hepatic drug metabolism. An area of concern and uncertainty in the care of patients with cirrhosis is the safe use of both prescription and over-the-counter medications.
  
  
  CONCLUSIONS
  Retrospective studies indicate a high incidence of adverse drug reactions (ADRs) among patients with cirrhosis related to use of certain medication classes including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and non-steroidal anti-inflammatory drugs. Conversely, use of appropriate medications, such as statins, may be decreased in this population due to fear of precipitating hepatotoxicity.
  
  
  CONCLUSIONS
  Pharmacotherapy in cirrhosis is an area of uncertainty and heterogeneity in clinical practice. Prescribing and dosing guidelines are needed to decrease the risk of serious ADRs in this high-risk patient population.
authors: Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA. hilscher.moira@mayo.edu.
authors: M B
authors: MB
authors: Hilscher
authors: Department of Pharmacy, Mayo Clinic, Rochester, MN, USA.
authors: L J
authors: LJ
authors: Odell
authors: Department of Pharmacy, Mayo Clinic, Rochester, MN, USA.
authors: L J
authors: LJ
authors: Myhre
authors: Department of Education Administration, Mayo Clinic, Rochester, MN, USA.
authors: L
authors: L
authors: Prokop
authors: Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
authors: J
authors: J
authors: Talwalkar
mesh_terms: D057911:Angiotensin Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use; D064420:Drug-Related Side Effects and Adverse Reactions / Q000209:etiology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D008099:Liver / Q000187:drug effects; D008103:Liver Cirrhosis / Q000188:drug therapy*; D012189:Retrospective Studies
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000894:Anti-Inflammatory Agents, Non-Steroidal; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: drug interaction; liver; pharmacists