Liver disease, drug contraindications

These drug are contraindicated in patients with known hypersensitivity to tire drug. Clomiphene is contraindicated in patients with liver disease, abnormal bleeding of undetermined origin, or ovarian cysts, and during... 

The drug may cause liver toxicity and is contraindicated in patients with preexisting liver disease. The ALT should be monitored monthly initially and periodically thereafter. Leflunomide may cause bone marrow toxicity a complete blood cell count with platelets is recommended monthly for 6 months and then every 6 to 8 weeks thereafter. It is teratogenic and should be avoided during pregnancy. 

Contraindications to heparin therapy include hypersensitivity to the drug, active bleeding, hemophilia, severe liver disease with elevated prothrombin time (PT), severe thrombocytopenia, malignant hypertension, and inability to meticulously supervise and monitor treatment. 

If the above findings occur, discontinue erythromycin estolate promptly. Erythromycin estolate is contraindicated for patients with a known history of sensitivity to this drug and for those with preexisting liver disease. 

Theophylline should be used with caution in patients with myocardial disease, liver disease, and acute myocardial infarction. The half-life of theophylline is prolonged in patients with congestive heart failure. Because of its narrow margin of safety, extreme caution is warranted when coadministering drugs, such as cime-tidine or zUeuton, that may interfere with the metabolism of theophylline. Indeed, coadministration of zileu-ton with theophylline is contraindicated. It is also prudent to be careful when using theophylline in patients with a history of seizures. 

These drugs are contraindicated in patients with thrombophlebitis, thromboembolic phenomena, and cardiovascular and cerebrovascular disorders or a past history of these conditions. They should not be used to treat vaginal bleeding when the cause is unknown. They should be avoided in patients with known or suspected tumors of the breast or other estrogen-dependent neoplasms. Since these preparations have caused aggravation of preexisting disorders, they should be avoided or used with caution in patients with liver disease, asthma, eczema, migraine, diabetes, hypertension, optic neuritis, retrobulbar neuritis, or convulsive disorders. 

Hepatotoxicity is not a particularly common form of adverse drug reaction and a patient with pre-existing liver disease does not have increased susceptibility to hepatic injury when taking drugs known to cause liver damage [1]. Therefore, drugs that are known to be hepato-toxic should not be contraindicated in this group of patients. There are... 

Sometimes the British National Formulary (BNF) [1] or the Summary of Product Characteristics (SPC) endorses the use of a drug in patients with liver disease. This is often sufficient and no further research is required. Fiowever, ensure that you also check the adverse effects of the drug, as these may preclude its use in some patients, even if there are no explicit contraindications or precautions regarding liver disease in the SPC. 

If the BNF and SPC do contraindicate or caution against the use of the drug in liver disease, then fnrther investigation and research is generally needed. This is becanse the recommendation may be based on a lack of or inconclusive data, rather than adverse data. In these situations, application of knowledge from first principles is often appropriate, and a risk-benefit assessment for yonr specific patient should be considered. Use of drugs outside their product licence may be considered appropriate in some situations. 

Despite the manufacturers of domperidone contraindicating its use in patients with liver disease [1, 2], it is the drug of choice in many liver centres as it has minimal side effects and can be used in all liver patients. In most liver patients the initial starting dose is 10 mg three times a day for adults and 200 pg/kg three times a day for children. However, as domperidone is extensively metabolised by the liver, the initial dose in patients with severe hepatic impairment or cirrhosis should be reduced by 50%, and gradually titrated up to a maximum of 10 mg three times a day, as accumulation of the drug may occur. 

The Summary of Product Characteristics (SPC) for each product states that all statins are contraindicated in active liver disease and in patients with persistent unexplained elevations of liver enzymes exceeding three times the upper limit of normal (ULN) [1, 2]. This is due to their extensive liver metabolism, their ability to cause raised transaminases and the risk of myopathy or rhabdomyolysis in the presence of reduced synthetic function, or to a drug interaction that reduces their metabolism. 

There is little to choose between the principal available drugs, nandrolone (Durabolin) (i.m. once a week) and stanozolol (Stromba) (orally), except that the latter is contraindicated in liver disease. 

Contraindications to oestrogen therapy include women who may have an oestrogen-dependent neoplasm, e.g. breast cancer, who may be pregnant, or have a disposition to thromboembolism. Hypertension, liver disease or gallstones, migraine, diabetes, uterine fibroids or endometriosis may all be made worse by oestrogen. These are not necessarily absolute contraindications, and HRT should not for instance be denied to a poly-symptomatic woman with mild hypertension. If necessary, it may be permissible to treat both the hypertension and the postmenopausal symptoms with separate drugs. 

Leflunomide has efficacy similar to that of methotrexate for treating rheumatoid arthritis. The drug may cause liver toxicity and is contraindicated in patients with pre-existing liver disease. Patients taking the drug should have ALT monitored monthly initially, and periodically thereafter as long as they continue treatment. 

It has been claimed that alcohol can increase the hepatotoxic effects of methotrexate. Two reports of patients treated for psoriasis indicate that this may be so in one, 3 out of 5 patients with methotrexate-induced cirrhosis were reported to have taken alcohol concurrently (2 patients greater than 85 g, one patient 25 to 85 g of alcohol per week), and in the other, the subject was known to drink excessively. The evidence is by no means conclusive and no direct causal relationship has been established. However, the manufacturers of methotrexate advise the avoidance of drugs, including alcohol, which have hepatotoxic potential, and contraindicate its use in patients with alcoholism or alcoholic liver disease. ... 

Dizziness. 4 Hallucinations. 4 Nervousness. Tachycardia. Tachypnea. Seizures. Lidocaine doesn t affect blood pressure, cardiac output or myocardial contractility. Lidocaine is ineffective against atrial arrhythmias. -0 Contraindicated in second- or third-degree AV block without pacing support Reduce drug dosage as ordered in patients with heart failure or liver disease. 0 Monitor patient closely for CNS changes. 

The barbiturates are contraindicated in patients with known hypersensitivity to the drugs. The barbiturates are used cautiously in patients with liver or kidney disease and those with neurological disorders. The barbiturates (eg, phenobarbital) are used with caution in patients with pulmonary disease and in hyperactive children. When barbiturates are used with other CNS depressants (eg, alcohol, narcotic analgesics, and antidepressants), an additive CNS depressant effect may occur. See Chapter 26 for additional information on the barbiturates. 

The MAOI antidepressant drag s are contraindicated in patients widi known hypersensitivity to die drug s, liver and kidney disease, cerebrovascular disease, hypertension, or congestive heart failure and in die elderly. These drag s are given cautiously to patients witii impaired liver function, history of seizures, parkinsonian symptoms, diabetes, or hyperthyroidism. 

The antipsychotics are contraindicated in patients with known hypersensitivity to the drug s, in comatose patients, and in those who are severely depressed, have bone marrow depression, blood dysera ias, Parkinson s disease (haloperidol), liver impairment, coronary artery disease, or severe hypotension or hypertension. 

The bile acid sequestrants are contraindicated in patients with known hypersensitivity to the drugs. Bile acid sequestrants are also contraindicated in those with complete biliary obstruction. These drags are used cautiously in patients with a history of liver or kidney disease Bile acid sequestrants are used cautiously during pregnancy (Pregnancy Category C) and lactation (decreased absorption of vitamins may affect the infant). 

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