🫀 Hepatic Dose Adjustment Key Points
UseBedside reminder of which drugs to reduce or avoid in liver disease and what to monitor. Not exhaustive — fol…
SourceChild-Pugh classification and product labelling for hepatic impairment
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
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Methodology · worked example, guidelines & full notes
Avoid hepatotoxins; monitor LFTs, bilirubin, INR and for encephalopathy.
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 | Sedatives / antiepileptics |
|---|
→Key pointSedatives / antiepileptics
- Benzodiazepines：Prefer non-oxidatively metabolised oxazepam/lorazepam/temazepam; avoid long-acting hepatic agents like diazepam (accumulation, precipitate encephalopathy)
- Valproate：Contraindicated/caution in liver disease (hepatotoxicity, hyperammonaemia)
- Carbamazepine/phenytoin：Hepatically metabolised — monitor levels and LFTs
| 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
Verification & sources · governance
FAQ
Frequently asked questions
- 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.
- Does Hepatic Dose Adjustment Key Points upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.