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Akhila S.*, Dinta Maria, Hephzibah Mathew, Jasmin Jacob and Jeena Joy


Liver plays a central role in the pharmacokinetics of majority of drugs. Liver dysfunction reduces the blood or plasma clearance of drugs that are eliminated by hepatic metabolism, affects plasma protein binding and thus influences the distribution and elimination of drugs. Dosage adjustment in patients with liver dysfunction is therefore essential for many drugs to avoid excessive accumulation of the drug, which may lead to serious adverse reactions. So our study is aimed to formulate dosage recommendation in patients with liver disease in a tertiary care teaching hospital. A prospective observational study was conducted in hepatic impaired patients on drug dosing for a period of 6 months in a tertiary care teaching hospital. The degree of hepatic impairment was calculated using Child-Pugh classification which incorporates 5 variables to assess severity of liver disease. Collected data were analyzed and dosage recommendations were formulated using Lexicomp and standard guidelines. 166 (35.09%) drugs required dosage recommendations from a total of 473 drugs evaluated in 52 patients. Out of 166 drugs, 50 drugs were found to be contraindicated, 73 drugs to be used with caution and 36 drugs to be monitored closely. Ondansetron, Torsemide and Amlodipine required dosage adjustment. From our study we concluded that drug dosing evaluation and concurrent feedback mechanism by the pharmacist can improve drug safety in patients with hepatic impairment. Formulating dosage recommendations can be beneficial in providing individualized dosage regimen and in clinical decision making for better health care system.

Keywords: Hepatic impairment, dosage adjustment, liver dysfunction, Child-Pugh.

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