Hepatic insufficiency

Known bleeding diathesis (includes renal and hepatic insufficiency) ... 

Lorazepam may be preferred over other benzodiazepines in patients with renal and/or hepatic insufficiency... 

Hepatic insufficiency Decrease of liver metabolism, leading to increased efficacy of warfarin... 

Although the pharmacokinetics of rifaximin in patients with renal insufficiency has not been specifically studied, its very low renal excretion makes any dose adjustment unnecessary. The same holds true for patients with hepatic insufficiency. In fact, the mean peak drug plasma concentrations (i.e. 13.5 ng/ml) detected in subjects with hepatic encephalopathy patients given rifaximin 800 mg 3 times daily for 7 days [34, 108] were not dissimilar to those found in healthy subjects [102] and patients with IBD [98], Indeed, in all the trials performed in this condition the drug has been well tolerated [33, 77],... 

HE is a central nervous system disturbance with a wide range of neuropsychiatric symptoms associated with hepatic insufficiency and liver failure. 

Approximately 20% of patients with chronic HBV infection develop complications of decompensated cirrhosis, including hepatic insufficiency and portal hypertension. HBV is a risk factor for development of hepatocellular carcinoma. 

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 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. 

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. 

Hypoglycemia Hepatic insufficiency may cause elevated repaglinide blood levels... 

Quinidine is rapidly absorbed from the Gl tract. Maximum effects of quinidine gluconate occur 30 to 90 minutes after IM administration onset is more rapid after IV administration. Activity persists for at least 6 to 8 hours. The average therapeutic serum levels are reported to be 2 to 7 mcg/mL. Toxic reactions may occur at levels from 5 to 8 mcg/mL or more. Quinidine is 80% to 90% bound to plasma proteins the unbound fraction may be significantly increased in patients with hepatic insufficiency. 

Renal, hepatic, or cardiac insufficiency Use with caution in renal, cardiac, or hepatic insufficiency because of potential toxicity. 

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). 

Hypertension - Usual dose is 5 mg once daily. Maximum dose is 10 mg once daily. Small, fragile, or elderly patients or patients with hepatic insufficiency may be started on 2.5 mg once daily this dose may also be used when adding amlodipine to other antihypertensive therapy. In general, titrate over 7 to 14 days proceed more rapidly if clinically warranted with frequent assessment of the patient. 

Angina (chronic stabie or vasospastic) - 5 to 10 mg, using the lower dose for elderly and patients with hepatic insufficiency. Most patients require 10 mg. 

Hypersensitivity to quinazolines (eg, doxazosin, prazosin, terazosin) moderate or severe hepatic insufficiency coadministration with potent CYP3A4 inhibitors (eg, ketoconazole, itraconazole, ritonavir). 

Speciai risk patients Patients on dialysis may develop orthostatic hypotension monitor blood pressure closely. Initiate treatment under close medical supervision for patients with biliary obstructive disorders or hepatic insufficiency. Correct the condition of patients with depletion of intravascular volume before initiating therapy and monitor closely. 

Losartan - Compared with healthy subjects, the total plasma clearance in patients with hepatic insufficiency was about 50% lower and the oral bioavailability was about 2 times higher. A lower starting dose is recommended. 

Telmisartan- As the majority of telmisartan is eliminated by biliary excretion, patients with biliary obstructive disorders or hepatic insufficiency can be expected to have reduced clearance. Use telmisartan with caution in these patients. 

Hepatic function impairment Because of the unknown effects of the increased exposure to ezetimibe in patients with moderate or severe hepatic insufficiency, ezetimibe is not recommended in these patients. 

Hepatic function impairment Use is not recommended in patients with moderate or severe hepatic insufficiency. 

Caution Recommended doses do not apply for adult patients with body weight less than 50 kg. Recommended doses do not apply to patients with renal or hepatic insufficiency or other conditions affecting drug metabolism and kinetics. Starting doses should be lower for elderly patients. 

Hepatic function impairment Increased exposure to alosetron is likely to occur in patients with hepatic insufficiency. 

Do not administer duloxetine to patients with hepatic insufficiency markedly increased exposure occurs. 

Hepatic function impairment Atomoxetine exposure (AUC) is increased, compared with normal subjects, in EM subjects with moderate (Child-Pugh Class B) (2-fold increase) and severe (Child-Pugh Class C) (4-fold increase) hepatic insufficiency. Dosage adjustment is recommended for patients with moderate or severe hepatic insufficiency (see Administration and Dosage). 

Renal failure and hepatic insufficiency - Measure serum levels to provide additional guidance for adjusting dosage however, this may not be practical. 

Children 50 to 100 mg/kg/day in divided doses. Continue treatment over a period of 5 to 6 days during this time, return protein to the diet incrementally. Chronic hepatic insufficiency may require up to 4 g/day over an indefinite period. 

Hepatic function Impairment A dosage reduction is recommended for patients with moderate hepatic insufficiency. There is no clinical experience in patients with severe hepatic insufficiency (Child-Pugh score greater than 9). 

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. 

Hepatic function impairment Exercise caution when administering saquinavir to patients with hepatic insufficiency. Exacerbation of chronic liver dysfunction, including portal hypertension, in patients with underlying hepatitis B or C, cirrhosis or other underlying liver abnormalities have been reported. 

Cirrhosis Reduce the dosage of indinavir to 600 mg every 8 hours in patients with mild to moderate hepatic insufficiency caused by cirrhosis. 

Hepatic function impairment Hepatitis including cases resulting in hepatic failure and death has been reported in patients treated with indinavir. Patients with hepatic insufficiency because of cirrhosis should have the dosage of indinavir lowered because of decreased metabolism. 

Known hypersensitivity to any of the ingredients of the product moderate to severe (Child-Pugh class B and C, respectively) hepatic insufficiency. 

Gastric distress (nausea and vomiting) is one of the most frequently reported adverse reactions. Bladder irritation (e.g., dysuria, polyuria, hematuria, and urgency) may occur. The mandelic salt can crystallize in urine if there is inadequate urine flow and should not be given to patients with renal failure. Patients with preexisting hepatic insufficiency may develop acute hepatic failure due to the small quantities of ammonia formed during methenamine hydrolysis. 

For oral therapy, cloxaciUin and dicloxacillin are comparable alternatives. Both undergo hepatic metabolism, and neither drug requires dose adjustment in patients with hepatic insufficiency. Additional pharmacokinetic data are in Table 45.1. Indications for cloxacillin or dicloxacillin include clinically mild staphylococcal infections like impetigo. 

The antipseudomonal penicillins undergo renal elimination (Table 45.1). Piperacillin and ticarcillin have minimal hepatic metabolism. In contrast, mezlocillin has significant hepatic metabolism and requires dose adjustment in patients with hepatic insufficiency. 

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