PHARMACOTHERAPY SESSION – Safe medication use in patients with cirrhosis

Link to EAHP Statements

• Section 1 – Introductory Statements and Governance: Statement – 1.1
• Section 4 – Clinical Pharmacy Services: Statements – 4.1, 4.2, 4.3, 4.4, 4.8
• Section 5 – Patient Safety and Quality Assurance: Statements – 5.1, 5.5

ACPE UAN: 0475-0000-23-005-L05-P – A knowledge-based activity

Abstract

The biotransformation and transport of medication are dependent on liver function. Hence, impaired liver condition can influence the pharmacokinetics and pharmacodynamics of medicines, especially of medication with a high hepatic extraction such as some analgesics, antidepressants and antihyperlipidemic medication. In 2013, it was estimated that 29 million persons were suffering from a chronic liver condition in the European Union. One common liver condition is cirrhosis.

Cirrhosis is a slowly progressive disease and results from ongoing inflammation of the liver. Liver architecture is changed into structurally abnormal nodules, fibrosis and subsequently loss of hepatocyte density and function. The severity of cirrhosis is classified with the Child-Pugh score. Precautions in medication use with cirrhosis are often included as warnings in the Summary of Product Characteristics (SmPC) without detailed advice on when to adjust dosage exactly or when to avoid certain medications. Studies show that in patients with cirrhosis, dosages of medication are incorrect and many patients experience adverse drug reactions.

For hospital pharmacists it is essential to understand when to intervene to prevent adverse drug reactions and toxicity. In this pharmacotherapy session, the characteristics of cirrhosis are highlighted together with practical advices on safe medication use in patients with cirrhosis.

Learning objectives

After this session, participants should be able to:

• Describe how the Child-Pugh score can define the severity of cirrhosis
• Know the most frequently prescribed ‘unsafe’ medicines in cirrhosis, and know ‘safe’ alternatives
• Find and apply the right safety advice and dosing strategies for patients with cirrhosis

Educational need addressed

Based on severity of cirrhosis, pharmacist could advice physicians on the right adjustments in pharmacotherapy. This seminar will focus on safe medication use in patients with cirrhosis and give guidance to pharmacists who review patients’ medication daily.

Keywords: Cirrhosis, hepatic impairment, medication safety, drug use evaluation, interventions, pharmacology, clinical decision support