Use of hepatotoxic drugs in chronic liver disease

Cirrhosis and chronic liver disease are common illnesses that cause high mortality and require treatment. Medication use in these patients may be challenging because of idiosyncratic or dose-dependent drug toxicity. Therefore, drug choice and drug dose adaptations play an important role. The objective of this clinical review is to discuss the literature about and challenges in drug use in patients with chronic liver disease. To make good decisions regarding drug choice and dose adjustments in these patients, well-defined clinical information about diagnoses and laboratory results (creatinine, international normalized ratio, bilirubin, and serologies) as well as in some instances, pathological findings like liver biopsies are needed. In a second step, these data should be organized in electronically supported clinical decision systems, which can then assist providers in making choices about medication selection and dosage. In summary, although substantial research has been done in the field of drug use in patients with liver dysfunction, a great deal also remains to be learned. Although many of these patients can now be identified, it is still very difficult to assess their individual level of hepatic function. The degree of risk associated with drug use and how best to use medications in these patients represents an important area for further study. In the future, pharmacogenomics and electronic linking of clinical data may well prove helpful for making decisions about optimal drug choices in this complex group of patients.