Reply To: Pharmacokinetic understanding for liver adjustments

Dear Naveed,

Kindly find this article regarding the effect of cirrhotic liver disease on drug metabolism through CYP system. This can give a general idea as chronic damage will have more profound effect than acute one unless the latter is a fulminant case.

Generally speaking, Dengue fever, by itself; necessitates supportive therapy rather than medications that require adjustment. For other medications that the patient may be already using like antihypertensives, antidiabetics and so on, I think that you can:-

1- Consider the specific drug monograph especially for extensively eliminated medications and adjust accordingly as mentioned earlier

2- Monitor clinical response of the patient and adjust accordingly, e.g BP, Glucose level,…

3- Avoid hepatotoxic medications and replace with safer ones

4- Consider alternatives for medications that are extensively eliminated hepatically, e.g Opiates, NSAIDs, Benzodiazepines….

To conclude, my opinion is that the effect of acute hepatic disease on CYP metabolism will depend on severity and duration (Chronic VS Acute) with probable lesser effect in case of mild short-term acute cases which may call for dose titration, starting with lower dose; with vigilant and clinically based judgment considering drug specific metabolism profile. This is evidenced by the referenced recommendations of no change in drug dosages in mild to moderate liver disease in many hepatically eliminated drugs.

Any further concerns are most welcomed.

My Best Regards,