Prescribing in Patients with liver disease

Liver is the hub of metabolic activity of the body. Indeed, most drugs are modified or metabolized in the liver. Thus, drugs that are dependent primarily on the liver for their systemic clearance are likely to have reduced elimination and subsequent accumulation, leading to excessive plasma drug concentrations and adverse effects.1 However, the effects of hepatic insufficiency on the pharmacokinetics of drugs are not consistent or predictable.2 Furthermore, the influence of hepatic disease on different drugs can be variable, despite their sharing the same metabolic pathway. Problems in forecasting drug kinetic behaviour are further enhanced by the additional impairment of kidney function which often ensues in advanced liver diseases.