Prescribing in liver disease

Patients with liver disease often require drug therapy. Because the liver is the main site of drug detoxification and elimination, each patient’s need for therapy must be carefully assessed; the choice of drug, its dose and the duration of therapy must be carefully considered 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, so the dose and drug should be individualized to the patient, who should then be carefully monitored, with the duration of treatment kept as short as possible.