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, patients must be carefully assessed for the need for therapy. If a drug is needed for a patient with liver disease, the choice of drug, its dose, and duration of therapy must be carefully considered in order to avoid adverse effects. Ideally, in patients with liver disease, it is better to choose a drug that has a large therapeutic index, is largely devoid of pharmacokinetic and pharmacodynamic interactions, is devoid of 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, and the drug used for the shortest period possible. The British National Formulary contains useful information on drugs that need to be either avoided or dose modified in patients with liver disease.