Hepatic Impairment

Question 1

Questions to ask in hepatic impairment?

Answer 1

1. What is the type of liver disease and cause?
2. What are the results of immunological/ virological screens and other diagnostic tests (biopsies)
3. Symptoms, extent and severity?
4. Liver function tests
5. How is patient’s renal function?

Question 2

Liver function tests

Answer 2

bilirubin, alkaline phosphatase, ALT, AST, GGT
and
albumin, INR
- Are they stable or changing?

Question 3

If requesting advice on dosage or suitability of a drug in hepatic dysfunction

Answer 3

• What agent would normally be used if the patient did not have liver dysfunction?
• Have alternatives been considered?

Question 4

If suspected that hepatic impairment is drug-induced

Answer 4

• Is the patient still taking the drug?
• Dose, frequency and duration of treatment of the suspected drug
• Type of liver injury
• How patient has been managed
• Which other drugs are being taken or were taken recently?
• Could there be another cause?