Prescribing in liver disease

Patients with liver disease often require drug therapy. Since the liver is the main site of drug detoxification and elimination in the body, each patient's need for therapy must be carefully assessed; the choice of drug, its dose, and duration of therapy must be carefully considered in order to avoid adverse effects. Ideally, one should choose a drug that has a high therapeutic index, is largely devoid of pharmacokinetic and pharmacodynamic interactions and hepatotoxic effects, and is renally eliminated. However, the ideal drug with these properties is often not available, and in such cases the dose and drug should be individualized to the patient, who should then be carefully monitored, the duration of treatment being kept as short as possible. The British National Formulary contains useful information on drugs that should be avoided or their dosage modified in patients with liver disease.