Adaptation des thérapeutiques médicamenteuses en cas d'insuffisance hépatocellulaire

Metabolic clearance in the liver is the major route for detoxification and elimination of a wide variety of drugs. Therefore, liver dysfunction impairs drugs' pharmacokinetics and pharmacodynamics. For now, there is no clinical or biological score available to correlate liver failure degree with drugs liver clearance. Child-Pugh stage B or C scores in cirrhosis, high serum creatinine level, sepsis as well as cytolysis are major risk factors for adverse side effects occurrence of administered drugs in liver failure. In such cases, acetaminophen, non-steroidal anti-inflammatory drugs and sedative psychotropic drugs are prohibited. In patients with liver failure, drugs prescriptions must be handled with care, looking after their side effects, their intensity and their duration, especially in case of multiple injections or drugs' continuous administration. Since algorithms are still missing for drugs adaptation in patients with liver failure, it is strongly recommended to look after drugs pharmacokinetics in critically ill patients with liver dysfunction. In patients with liver failure, evaluation of liver toxicity has to be done before any prescription. It can be done thanks to the French liver toxicity network called Hepatox® and has to be completed by drugs residues screening tests.