🫀 Hepatic Dose Adjustment Key Points
Adjustment and avoidance points for common drugs in hepatic impairment, organised by drug class with Child-Pugh framing. Browser-side reference.
Avoid hepatotoxins; monitor LFTs, bilirubin, INR and for encephalopathy.
Paste the link in Slack, Teams, X, or LinkedIn — the preview image comes from this page’s Open Graph card.
When to use
Bedside reminder of which drugs to reduce or avoid in liver disease and what to monitor. Not exhaustive — follow the product label.
How it works
No quantitative hepatic index like eGFR; grade by Child-Pugh (A/B/C) and reduce hepatically-cleared drugs in B/C.
Key points
- Avoid hepatotoxins; monitor LFTs, bilirubin, INR and for encephalopathy.
- Prefer oxazepam/lorazepam over long-acting benzodiazepines.
- Statins are contraindicated in active liver disease; warfarin needs close INR monitoring.
- Watch for hidden acetaminophen in combination products.
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| View | General principles |
|---|
→Key pointGeneral principles in hepatic impairment
- Grading：No eGFR-like quantitative index; use Child-Pugh (A/B/C); reduce hepatically-cleared drugs in B/C
- Avoid：Avoid hepatotoxins; monitor LFTs, bilirubin, INR and for encephalopathy
- Pharmacokinetics：Low albumin → free drug ↑; portosystemic shunting → first-pass ↓ raising oral bioavailability
| View | Other high-risk |
|---|
→Key pointOther high-risk
- Antipsychotics/antidepressants：Mostly hepatically metabolised — reduce in severe liver disease
- Immunosuppressants：Tacrolimus/cyclosporine via CYP3A4 — monitor levels
- Note：Acetaminophen hidden in combination products is easily added cumulatively
Frequently asked questions
- What is Hepatic Dose Adjustment Key Points?
- Adjustment and avoidance points for common drugs in hepatic impairment, organised by drug class with Child-Pugh framing. Browser-side reference.
- How is Hepatic Dose Adjustment Key Points calculated? What is the core formula?
- No quantitative hepatic index like eGFR; grade by Child-Pugh (A/B/C) and reduce hepatically-cleared drugs in B/C.
- When is Hepatic Dose Adjustment Key Points used?
- Bedside reminder of which drugs to reduce or avoid in liver disease and what to monitor. Not exhaustive — follow the product label.
- What are the key clinical points for Hepatic Dose Adjustment Key Points?
- Avoid hepatotoxins; monitor LFTs, bilirubin, INR and for encephalopathy. Prefer oxazepam/lorazepam over long-acting benzodiazepines. Statins are contraindicated in active liver disease; warfarin needs close INR monitoring. Watch for hidden acetaminophen in combination products.
- What are the limits and cautions when using Hepatic Dose Adjustment Key Points?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is Hepatic Dose Adjustment Key Points calculated in practice? Can you show a worked example?
- Inputs: View General principles → Result: Key point General principles in hepatic impairment（Grading: No eGFR-like quantitative index; use Child-Pugh (A/B/C); reduce hepatically-cleared drugs in B/C, Avoid: Avoid hepatotoxins; monitor LFTs, bilirubin, INR and for encephalopathy, Pharmacokinetics: Low albumin → free drug ↑; portosystemic shunting → first-pass ↓ raising oral bioavailability） Inputs: View Other high-risk → Result: Key point Other high-risk（Antipsychotics/antidepressants: Mostly hepatically metabolised — reduce in severe liver disease, Immunosuppressants: Tacrolimus/cyclosporine via CYP3A4 — monitor levels, Note: Acetaminophen hidden in combination products is easily added cumulatively）