Dosage adjustment for hepatic dysfunction

Abstract

Periáñez-Párraga et al. (1) provide dose adjustment recommendations for 186 drugs in hospitalized patients with chronic liver dysfunction (LD). In this article, a literature review about dosage adjustment was performed and, in case no information was found, the adjustment recommendations were given according to the process defined by Delcò et al. (2). The final recommendation was established for 186 reviewed drugs; 73.1 % of them needed quantitative or qualitative adjustment. Recommendation was defined according to the product characteristics summary in 92 drugs (49.5 %), DrugDex Micromedex 49 (26.3 %) and WHO 35 (18.8 %). The recommendations of 6 drugs (3.2 %) were based on previous publications for the group of antimicrobials in 2009 and in 4 drugs a theoretical adjustment recommendation based on the proposal defined by Delcò et al. (2) was given. We performed a literature search in Medline database using the combination of the following keywords: "pharmacokinetics", "liver disease", "hepatic metabolism", "dose adjustment" and the specific generic name of each drug evaluated. The references of the papers found were screened for additional information in product characteristics summary, DrugDex-Micromedex (3); Drug information handbook (4); British National Formulary (5); FDA (6) and EMEA (7) guidelines as well as WHO recommendations (8). Final recommendation is different in 46 drugs comparing with those provided by Periañez-Parraga et al. (1) (Table I).