Hepatic function, impaired

Hepatic function impairment Use this preparation with extreme caution in the presence of serious impairment of liver function. 

Hepatic function impairment Exposure to anagrelide is increased 8-fold in patients with moderate hepatic impairment. Use of anagrelide in patients with severe hepatic impairment has not been studied. In patients with moderate hepatic impairment, dose reduction is required carefully monitor patients for cardiovascular effects. Pregnancy Category C. 

Hepatic function impairment Elevations of hepatic enzymes and hepatic failure have been reported in association with dipyridamole administration. Dipyridamole can be dosed without restriction as long as there is no evidence of hepatic failure. Avoid aspirin in patients with severe hepatic insufficiency. 

Hepatic function impairment The average plasma concentration in patients with advanced cirrhosis was slightly higher than that seen in older subjects. Because of limited experience in patients with severe hepatic disease, who may have bleeding diatheses, the use of ticlopidine is not recommended. 

Hepatic function impairment In patients with mild or moderate hepatic insufficiency, decrease the initial dose of treprostinil to 0.625 ng/kg/min ideal body weight increase cautiously. Treprostinil has not been studied in patients with severe hepatic insufficiency. 

Route of administration Treprostinil is indicated for subcutaneous or IV use only. Renal/Hepatic function impairment Use caution in patients with hepatic or renal impairment. 

Priapism Priapism has been reported from postmarketing surveillance of tinzaparin as a rare occurrence. In some cases, surgical intervention was required. Renal/Hepatic function impairment Delayed elimination of LMWHs may occur with severe liver or kidney insufficiency. Use with caution. 

Hepatic function impairment Heparin half-life may be prolonged in liver disease. Eideriy A higher incidence of bleeding has occurred in women older than 60 years of age. 

Hepatic function impairment Patients with a history of jaundice during pregnancy have an increased risk of recurrence while on estrogen-containing OCs. If jaundice develops in any patient on estrogen, discontinue medication and investigate the cause. Estrogens may be poorly metabolized in impaired liver function use with caution. 

Premenopausal use There is no indication for premenopausal use of raloxifene. Hepatic function impairment Raloxifene was studied, as a single dose, in Child-Pugh class A patients with cirrhosis and serum total bilirubin ranging from 0.6 to 2 mg/dL. Plasma raloxifene concentrations were approximately 2.5 times higher than in controls and correlated with total bilirubin concentrations. Safety and efficacy have not been evaluated further in patients with severe hepatic insufficiency. Carcinogenesis In long term carcinogenicity studies in animals there was an increased incidence of ovarian tumors, testicular interstitial cell tumors, and prostatic adenocarcinomas. 

Hepatic function impairment Use caution in those patients with liver function abnormalities since finasteride is metabolized extensively in the liver. 

Hepatic function impairment Because dutasteride is extensively metabolized and has a half-life of approximately 5 weeks at steady state, use caution in the administration of dutasteride to patients with liver disease. 

Hepatic function impairment Monitor patients with moderate to severe liver disease for increased signs and/or symptoms of hypercorticism. Consider reducing the dose of budesonide in these patients. 

Hepatic function impairment Patients with impaired liver function may be exposed to higher concentrations of repaglinide and its metabolites. Use repaglinide cautiously in patients with impaired liver function. Utilize longer intervals between dose adjustments to allow full assessment of response. 

Hepatic function impairment Use nateglinide with caution in patients with chronic liver disease. Use with caution in patients with moderate to severe liver disease because such patients have not been studied. 

Renal/Hepatic function impairment Careful glucose monitoring and dose adjustments of insulin may be necessary in these patients. Insulin requirements may... 

Renal/Hepatic function impairment Hepatic impairment may result in inadequate release of glucose in response to hypoglycemia. Renal impairment may cause decreased elimination of sulfonylureas leading to accumulation producing hypoglycemia. 

Hepatic function impairment Because impaired hepatic function has been associated with cases of lactic acidosis, avoid metformin in patients with clinical or laboratory evidence of hepatic disease. 

Hepatic function impairment- Use with caution in patients with hepatic impairment. Do not initiate rosiglitazone therapy if the patient exhibits clinical evidence of active liver disease or increased serum transaminase levels (ALT more than 2.5 times the ULN) at start of therapy. Liver enzyme monitoring is recommended in all patients prior to initiation of therapy with rosiglitazone and periodically thereafter. 

Hepatic function impairment- Do not initiate pioglitazone therapy if the patient exhibits clinical evidence of active liver disease or increased serum... 

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. 

Renal/Hepatic function impairment For patients with moderate renal insufficiency (Ccr greater than 40 mL/min) or hepatic insufficiency, the recommended dosage is 400 mg/day given in divided doses (either 100 mg every 6 hours for immediate release or 200 mg every 12 hours for controlled release). 

Renal function impairment Reduce dosage in impaired renal function. Carefully monitor ECG for signs of overdosage. The controlled-release form is not recommended for patients with severe renal insufficiency (Ccr up to 40 mL/min). Hepatic function impairment Impairment increases plasma half-life reduce dosage in such patients. Carefully monitor the ECG. Patients with cardiac dysfunction have a higher potential for hepatic impairment. 

Renal/Hepatic function impairment Use caution with repeated or prolonged use in liver or renal disease possible toxic accumulation may occur. 

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 In general, patients with renal failure will require the usual doses of mexiletine. Patients with severe liver disease, however, may require lower doses and must be monitored closely. Similarly, marked right-sided CHF can reduce hepatic metabolism and reduce the dose needed. 

Hepatic function impairment Since mexiletine is metabolized in the liver, and hepatic impairment prolongs the elimination half-life, carefully monitor patients with liver disease. Observe caution in patients with hepatic dysfunction secondary to CHF. Abnormal liver function tests have been reported, some in the first few weeks of therapy with mexiletine. Most have occurred along with CHF or ischemia their relationship to mexiletine has not been established. 

Hepatic function impairment Because flecainide elimination from plasma can be markedly slower in patients with significant hepatic impairment, do not use in such patients unless the potential benefits outweigh the risks. If used, make dosage increases very cautiously when plasma levels have plateaued (after more than 4 days). 

Elderly/Hepatic function impairment- In patients more than 65 years of age or patients with hepatic function impairment. A starting dose not exceeding 10 mg/day is recommended in patients older than 65 years of age or patients with hepatic function impairment. 

Hepatic function impairment The pharmacokinetics, bioavailability and patient response to verapamil and nifedipine may be significantly affected by hepatic cirrhosis. 

Hepatic function impairment Because iloprost elimination is reduced in patients with impaired liver function, exercise caution during iloprost therapy in patients with at least Child-Pugh class B hepatic impairment. 

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/Hepatic function impairment- In patients with renal dysfunction (Ccr less than 40 mL/min) or hepatic impairment (hepatitis or cirrhosis), use an initial daily dose of 2.5 mg and use caution in dose titration. 

In the first 2 weeks post-MI, caution is advised and careful dose titration is especially important, particularly in patients with markedly impaired ventricular function. Intraoperative and postoperative tachycardia and hypertension Do not use esmolol as the treatment for hypertension in patients in whom the increased blood pressure is primarily caused by the vasoconstriction associated with hypothermia. Renal/Hepatic function impairment Use with caution. 

Hepatic function impairment Drug metabolism may be diminished. 

Hypersensitivity reactions While taking -blockers, patients with a history of severe anaphylactic reaction to a variety of allergens may be more reactive to repeated challenge, either accidental, diagnostic, or therapeutic. Such patients may be unresponsive to the usual doses of epinephrine used to treat allergic reaction. Renal/Hepatic function impairment Rarely, use of carvedilol in patients with CHF has resulted in deterioration of renal function. Patients at risk appear to be those with low blood pressure (systolic BP less than 100 mm Hg), ischemic heart disease. 

Hepatic function impairment Use with caution in patients with previous liver disease or dysfunction. 

Hepatic function impairment Administer doxazosin and alfuzosin with caution to patients with evidence of impaired hepatic function or to patients receiving drugs known to influence hepatic metabolism. 

Renal/Hepatic function impairment- For patients with a Ccr less than 30 mL/min or with hepatic cirrhosis, the recommended starting dose, based on clinical and pharmacokinetic data, is 0.5 mg/day. Titrate as described above to the optimal response. 

Hepatic function impairment Patients with impaired liver function could develop markedly elevated plasma levels of unchanged fosinopril or ramipril. In patients with alcoholic or biliary cirrhosis, the rate, but not extent of fosinopril hydrolysis was reduced. Quinaprilat concentrations are reduced in alcoholic cirrhosis. 

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. 

Renal/Hepatic function impairment- Use a starting dose of 10 mg/day in significant renal or hepatic function impairment. 

Hepatic function impairment Marked persistent increases (greater than 3 times ULN) in serum transaminases occurred in patients treated with all agents ranging in frequency from less than 1% to 1.9%. When the drug was interrupted or discontinued or the dosage was reduced, transaminase levels usually fell slowly to... 

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