Hepatic clearance impaired

Bile dysfunctions Capacity of hepatical clearance, impaired enterohepatic circulation... 

Hepatic function impairment Subjects with hepatic disease had a 28.3% decrease in plasma clearance of nalmefene compared with controls (0.56 vs 0.78 L/h/kg, respectively). Elimination half-life increased from 10.2 to 11.9 hours in the hepatically impaired. No dosage adjustment is recommended because nalmefene will be administered as an acute course of therapy. 

Hepatic function impairment Mean total clearance is decreased to 40% to 60% of normal in patients with moderate liver dysfunction and to 25% of normal in patients with severe liver dysfunction compared with age-matched healthy subjects. This results in a prolongation of the half-life from 0.8 hours in healthy subjects to 1.3 hours in patients with moderate hepatic impairment and 2.4 hours in severely impaired patients. 

Hepatic function impairment Propafenone is highly metabolized by the liver administer cautiously to patients with impaired hepatic function. The clearance of propafenone is reduced and the elimination half-life increased in patients with significant hepatic dysfunction. The dose of propafenone should be approximately 20% to 30% of the dose given to patients with normal hepatic function. 

Renal/Hepatic function impairment- Reduce the daily dose by 50% when creatinine clearance is less than 50 mL/min/1.73. Reduce by 75% when it is less than 25 mL/min/1.73. Use cautiously in impaired hepatic function. 

Renal function impairment No correlation was observed between plasma clearance of epierenone and creatinine clearance. Epierenone is not removed by hemodialysis. Hepatic function impairment In 16 subjects with mild to moderate hepatic impairment who received 400 mg of epierenone, no elevations of serum potassium above 5.5 mEq/L were observed. The mean increase in serum potassium was 0.12 mEq/L in patients with hepatic impairment and 0.13 mEq/L in normal controls. The use of epierenone in patients with severe hepatic impairment has not been evaluated. 

Hepatic function impairment In volunteers with hepatic cirrhosis, sildenafil clearance was reduced. Consider an initial sildenafil dose of 25 mg in these patients. In patients with mild or moderate hepatic impairment, do not exceed a 10 mg dose of tadalafil. Because of insufficient information in patients with severe hepatic... 

Hepatic function impairment The elimination half-life of tolterodine was longer in cirrhotic patients (mean, 8.7 hours) than in healthy, young, and elderly volunteers (mean, 2 to 4 hours). The clearance of oral tolterodine was substantially lower in cirrhotic patients (approximately 1.1 L/h/kg) than in the healthy volunteers (approximately 5.7 L/h/kg). 

Hepatic function impairment The clearance of zafirlukast is reduced in patients with hepatic impairment. 

Hepatic function impairment- The maximum decrease expected in the clearance of almotriptan caused by hepatic impairment is 60%. Therefore, do not exceed the maximum daily dose of 12.5 mg over a 24-hour period, and use a starting dose of 6.25 mg. 

Hepatic function impairment- Administer zolmitriptan with caution in patients with liver disease, generally using doses less than 2.5 mg. Patients with moderate to severe hepatic impairment have decreased clearance of zolmitriptan significant elevation in blood pressure was observed in some patients. 

Elderly and renal/hepatic function impairment- The clearance of mirtazapine is reduced in elderly patients and in patients with moderate to severe renal or hepatic impairment. 

Elderly/Hepatic function impairment- These patients have been observed to have decreased fluvoxamine clearance. It may be appropriate to modify initial dose and subsequent titration. 

Hepatic function impairment Treat patients with mild to moderate hepatic impairment with zaleplon 5 mg because of reduced clearance. Do not use in patients with severe hepatic impairment. 

Hepatic function impairment Zaleplon is metabolized primarily by the liver and undergoes significant presystemic metabolism. Consequently, the oral clearance of zaleplon was reduced by 70% and 87% in compensated and decompensated cirrhotic patients, respectively. 

Renal/Hepatic function impairment- Because of an increased fraction of unbound phenytoin in patients with renal or hepatic disease, or in those with hypoalbuminemia, interpret total phenytoin plasma concentrations with caution. Unbound phenytoin concentrations may be more useful in these patients. After IV administration, fosphenytoin clearance to phenytoin may be increased without a similar increase in phenytoin clearance. This has the potential to increase the frequency and severity of adverse events. 

Hepatic function Impairment In hepatically impaired patients, administer topiramate with caution because clearance may be decreased. 

Hepatic function impairment- Because patients with hepatic impairment may have higher plasma levels and lower clearance, ropinirole should be titrated with caution in these patients. 

Renal/Hepatic function impairment Anticipate some influence of hepatic impairment on drug kinetics (reduced clearance). Only severe renal impairment should affect clearance of nicotine or its metabolites from circulation. 

Hepatic function impairment Observe caution. Decreased clearance may occur these agents are partly metabolized in the liver. 

Hepatic function impairment There are no data in patients with severe cirrhosis. Dosage adjustment is recommended in patients with mild-to-moderate cirrhosis. Eideriy Norfloxacin is eliminated more slowly because of decreased renal function. The apparent half-life of ofloxacin is 6 to 8 hours, compared to approximately 5 hours in younger adults. Lomefloxacin plasma clearance was reduced by 25% and the AUC was increased by approximately 33% in the elderly. 

Renai/Hepatic function impairment The safety and pharmacokinetics of rimantadine in renal and hepatic insufficiency only have been evaluated after single dose administration. In a single dose study of patients with anuric renal failure, the apparent clearance was approximately 40% lower and the elimination half-life was 1.6-fold greater than that in healthy controls. In a study of 14 people with chronic liver disease (mostly stabilized cirrhotics), no alterations in the pharmacokinetics were observed after a single dose of rimantadine. However, the apparent clearance of rimantadine following a single dose to 10 patients with severe liver dysfunction was 50% lower than that reported for healthy subjects. Because of the potential for accumulation of rimantadine and its metabolites in plasma, exercise caution when patients with renal or hepatic insufficiency are treated with rimantadine. 

Possible differences exist for tolbutamide (short duration of action, hepatic clearance), potential preferred choice in older patients with poor general physical status and renal impairment... 

Some drugs are metabolized so readily that even marked reduction in liver function does not significantly prolong their action. However, cardiac disease, by limiting blood flow to the liver, may impair disposition of those drugs whose metabolism is flow-limited (Table 4-7). These drugs are so readily metabolized by the liver that hepatic clearance is essentially equal to liver blood flow. Pulmonary disease may also affect drug metabolism, as indicated by the impaired... 

Hepatic remnant clearance impaired due to apo-E abnormality patients only express the apo-E2 isoform that interacts poorly with the apo-E receptor Elevated production of VLDL associated with glucose intolerance and hyperinsuLinaemia... 

TABLE 7.5 Correlation of Laboratory Test Results with Impaired Hepatic Clearance ... 

Patients with liver disease have an increased susceptibility to certain drugs due to decreased hepatic clearance for drugs metabolized by the liver or due to enhanced sensitivity. For example, impaired hepatic metabolism can precipitate central nervous system (CNS) toxicity in patients on theophylline, phenytoin, or lidocaine or ergot poisoning on ergotamine. ... 

The syndrome of acute hypotension, adult respiratory distress syndrome, non-cardiogenic pulmonary edema, anemia, coagulopathy, and anaphylactic reactions after the administration of dextran 70 is referred to as the dextran syndrome (36-39). Factors other than acute volume overload due to intravascular absorption of dextran are thought to account for the syndrome. A combination of diverse pathophysiological factors may be responsible, namely direct pulmonary toxicity, activation of the coagulation cascade, release of vasoactive mediators, hypotension, pulmonary edema, intravascular intravasation of fluids, dilution of blood, and impaired renal and hepatic clearance. Cases of pulmonary edema are described under the section Respiratory. 

Because lidocaine undergoes nearly complete first-pass hepatic metabolism by CyP 3 A4 and 2D6 when administered orally, it is administered only as an intravenous or intramuscular injection. Once in the blood, it is 50% bound to protein, mainly to AAG and albumin. Clearance of lidocaine is very rapid. The distribution half-life is -0.5 hour, and the elimination half-life is 1 to 1.5 hours. Reduced hepatic function impairs clearance and causes prolonged elimination and accumulation of the drug. This is due both to reduced blood flow to the liver (seen in heart failure) and to decreased metabofism of lidocaine. The end effect is lidocaine intoxication if the dose is not adjusted to account for this decreased metabolic rate. 

The important uses of laboratory tests in acute hepatitis are to identify individuals with fulminant hepatic failure, document recovery, and determine clearance of any infectious agents. The most important tests in determining extent of injury are not plasma activities of cytosolic enzymes, but evidence of impaired liver function. The most important indicator of prognosis in acute hepatitis is impairment in synthetic functions of which PT is a widely accepted indicator. In acute viral or alcoholic hepatitis, PT more than 15... 

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