to guide clinicians managing medications in liver disease.

StephenW

Disclosures The authors have stated that they have no interests which might be
perceived as posing a conflict or bias.

Copyright © 2010 Blackwell Publishing Ltd

ABSTRACT
     
Objective: Reviewing the current literature to guide clinicians managing
medications in the setting of liver disease.

Literature sources: Using the terms liver disease, medication management, and
therapeutic monitoring, a literature review was conducted to identify
peer-reviewed articles in MEDLINE (1966–April 2009). Reference citations
were reviewed as an additional resource. Published English-language
literatures, articles and trials were reviewed. Emphasis was placed on
prospective, randomised, double-blind, placebo-controlled clinical trials.

Question synthesis: An informed decision on how to manage medications in the
setting of liver disease should account for changes that transpire in a
medication's first-pass metabolism, protein binding, volume of distribution,
clearance and pharmacodynamic interactions. To incorporate these issues within
one's thought process, clinicians can utilise the following six questions to
evaluate a medication use: (i) Is the patient experiencing acute or chronic
liver failure? (ii) Does the drug have high hepatic first-pass metabolism?
(iii) Is the medication highly protein-bound? (iv) Is there a change in the
volume of distribution for the medication? (v) Is the clearance of the
medication significantly altered? and (vi) Is there a pharmacodynamic
interaction with the medication?

Conclusions: The introduction and use of six clinically relevant questions in
the setting of liver disease can serve as a guide to clinicians who manage
patients with liver disease.



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