M B Hilscher1, L J Odell2, L J Myhre2, L Prokop3, J Talwalkar4. 1. Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA. hilscher.moira@mayo.edu. 2. Department of Pharmacy, Mayo Clinic, Rochester, MN, USA. 3. Department of Education Administration, Mayo Clinic, Rochester, MN, USA. 4. Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Abstract
WHAT IS KNOWN AND 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. COMMENT: 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. WHAT IS NEW AND CONCLUSION: 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.
WHAT IS KNOWN AND 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. COMMENT: 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. WHAT IS NEW AND CONCLUSION: 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: Rianne A Weersink; Margriet Bouma; David M Burger; Joost P H Drenth; S Froukje Harkes-Idzinga; Nicole G M Hunfeld; Herold J Metselaar; Margje H Monster-Simons; Katja Taxis; Sander D Borgsteede Journal: Drug Saf Date: 2018-06 Impact factor: 5.606