Prescribing in patients with abnormal liver function tests.

BACKGROUND The prescribing of medicines to patients with abnormal liver function tests (LFTs) requires careful consideration. Every effort must be made to establish the cause of the abnormal liver function. Whether the patient has cirrhosis also needs to be determined, as this will have broad reaching implications for prescribing. OBJECTIVE Two aspects of prescribing medications to patients with abnormal LFTs will be covered in this review: the use of potentially hepatotoxic drugs in patients with abnormal LFTs, and when to consider dose modification in patients with cirrhosis. DISCUSSION Idiosyncratic drug reactions are equally common in patients with normal or abnormal liver function. In advanced liver disease, drugs with predominant hepatic metabolism and/or excretion, particularly those with a narrow therapeutic index, should be used with caution. In the presence of decompensated cirrhosis, prescribing practices are likely to need altering.