[Drug therapy in liver diseases: problems in intensive care]

Most analgesics, antiarrhythmics, antiepileptics, theophylline and sedatives are inactivated by hepatic biotransformation. The use of these drugs in intensive care patients with abnormal liver function may be difficult because no reliable laboratory tests are available to predict the pharmacokinetic changes. Measurement of serum drug levels is the best method for individualized dosage adaptation, but the possibilities of routine drug monitoring are limited. To avoid toxic drug accumulation, agents with predominantly renal elimination should be selected. If no such alternatives exist, treatment should be initiated in a reduced dose and then modified according to the pharmacological effects observed.