Liver impairment

It is important to use these drag with caution in patients with a history of gastrointestinal disorders, renal disease, or liver impairment. The neuromuscular blocking action of die lincosamides poses a danger to patients widi myasthenia gravis (an autoimmune disease manifested by extreme weakness and exhaustion of die muscles). 

This drug is contraindicated in individuals who have had previous hypersensitivity reactions to pentamidine isethionate. Pentamidine isethionate is used cautiously in patients with hypertension, hypotension, hyperglycemia, renal impairment, diabetes mellitus, liver impairment, bone marrow depression, pregnancy (Category C), or lactation. 

Older adults are particularly susceptible to a potentially fatal hepatitis when taking isoniazd, especially if they consume alcohol on a regular basis. Two other antitubercular drugs rifampin and pyrazinamide, can cause liver dysfunction in the older adult. Careful observation and monitoring for signs of liver impairment are necessary (eg, increased serum aspartate transaminase, increased serum alanine transferase, increased serum bilirubin, and jaundice). 

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 estrogens are used cautiously in patients with gallbladder disease, hypercalcemia (may lead to severe hypercalcemia in patients with breast cancer and bone metastasis), cardiovascular disease, and liver impairment. 

In the present study the investigations on the liver impairment in experimental animals, caused by bromobenzene, dibromobenzenes, hexabromobenzene and tetrabromobisphenol were described. 

The results obtained after 7-fold administration of all studied compounds, suggest that these compounds cause disturbances in the heame biosynthesis pathway changes in the activities of ALA-D and ALA-S were observed. Such results suggest the possibility of liver impairment of porphyrogenic type as a result of multiple administration of brominated compounds. 

The substance may have effects on the liver, resulting in liver impairment. Animal tests show that this substance possibly causes toxicity to human reproduction or development. 

Zolpidem, chemically unrelated to benzodiazepines or barbiturates, acts selectively at the y-aminobutyric acidA (GABAA)-receptor and has minimal anxiolytic and no muscle relaxant or anticonvulsant effects. It is comparable in effectiveness to benzodiazepine hypnotics, and it has little effect on sleep stages. Its duration is approximately 6 to 8 hours, and it is metabolized to inactive metabolites. Common side effects are drowsiness, amnesia, dizziness, headache, and GI complaints. Rebound effects when discontinued and tolerance with prolonged use are minimal, but theoretical concerns about abuse exist. It appears to have minimal effects on next-day psychomotor performance. The usual dose is 10 mg (5 mg in the elderly or those with liver impairment), which can be increased up to 20 mg nightly. Cases of psychotic reactions and sleep-eating have been reported. 

Other important components of the initial evaluation include a medical evaluation including both a medical history and physical examination. This can identify medical consequences of substance abuse, such as liver impairment from chronic alcohol abuse or sinus complications from cocaine use, as well as reveal needle tracks from a variety of self-injection sites that might not be readily apparent to casual observation. 

When used for detoxification, phenobarbital is given in equal doses four times a day. The maximum daily dose of phenobarbital is 600 mg, but much lower doses are usually sufficient. The phenobarbital dose is lowered (i.e., tapered) by about 20% per day. If the patient is too drowsy, then a dose should be skipped. If breakthrough withdrawal symptoms continue to occur, then the pace of the detoxification should be slowed. Before using phenobarbital, liver function tests should be obtained. All barbiturates depend greatly on the liver to be metabolized. Alcoholics with cirrhosis or other forms of liver impairment may have difficulty clearing phenobarbital. Phenobarbital should not be used in patients with poor liver function. In addition, the barbiturates can worsen a medical condition known as porphyria and should be avoided in those with this disorder. Phenobarbital, as noted, is seldom used today for alcohol detoxification. 

In the presence of cirrhosis or other liver impairment, lorazepam or oxazepam should be utilized for detoxification. These two benzodiazepines have no active hepatic metabolites and are generally considered safer choices for patients with liver damage. Once the starting point for the taper is determined, the dose is decreased by 10-20% per day. It is important to note that this rate of taper is much faster than that used for patients treated chronically with benzodiazepines who are discontinuing their anxiolytic in order to determine if it is still needed for control of symptoms. In that case, the rate of decrease is 10-20% per week. Should the patient display... 

Dydrogesterone is a progesterone analogue. One of its indications is endometriosis, in which case dydrogesterone is administered at a dose of 10 mg two to three times daily. Progestogens are contraindicated in severe liver impairment and in patients with a history of liver tumours. 

Hypersensitivity to the drug presence of hematopoietic disorders such as neutropenia and thrombocytopenia or a history of TTP presence of a hemostatic disorder or active pathological bleeding severe liver impairment. 

Hepatic function impairment SSRIs are metabolized extensively by the liver. Use with caution in patients with severe liver impairment. 

Hepatic function impairment- For patients with severe liver impairment (Child Pugh class C), do not exceed a dose of 20 mg. 

Ethanol produces central nervous system depression over a wide range of doses. Its effects are additive or sometimes more than additive with other central nervous system depressants. Symptoms often associated with acute alcohol intoxication include increase in self-confidence, loss of inhibitions, euphoria, and loss of judgment. With increasing doses motor and intellectual impairment become prominent. Chronic abuse of ethanol leads to severe liver impairment (see Chapter 35). 

Dosage in liver impairment Mild-moderate-, use caution, reduce dosage Severe-, use extreme caution. Maximum dose WellfatriM 75 mg/day Wellbutrin SR-. 100 mg/day or 150 mg every other day Wellbutrin XL-. 150 mg every other day Zyban-. 150 mg every other... 

Dosaye in renal impairment Dosage modification is usually unnecessary but liver and renal function test results should be monitored in those with both renal and liver impairment or severe renal impairment. 

Dosage in liver impairment 100 mg q6h (200 mg q 12h with extended-release). Dosage in cardiomyopathy, cardiac decompensation No loading dose 100 mg q6-8h with gradual dosage adjustments. 

Contraindications Cardiovascular disease (CVD), cerebrovascular disease, liver impairment, pheochromocytoma... 

The BZs are all metabolized in the liver via the hepatic cytochrome P450 (CYP) enzymes through one or both of the following pathways phase I oxidation and dealkylation, and/or phase II conjugation to glucuron-ides, sulfates, and acetylated compounds. Diazepam, chlordiazepoxide, and flurazepam all undergo both phase 1 and phase 11 metabolism. Lorazepam, lorme-tazepam, oxazepam, and temazepam are all metabolized by phase 11 alone and are better tolerated by patients with liver impairment. 

Proton pump inhibitors undergo rapid first-pass and systemic hepatic metabolism and have negligible renal clearance. Dose reduction is not needed for patients with renal insufficiency or mild to moderate liver disease but should be considered in patients with severe liver impairment. Although other proton pumps exist in the body, the H+,K+ ATPase appears to exist only in the parietal cell and is distinct structurally and functionally from other H+ -transporting enzymes. 

Increased liver function tests - Mrs CR s alanine aminotransferase (ALT), alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) levels are all increased above the normal ranges and indicate moderate liver impairment. This may have implications on the ability of the liver to metabolise drugs and must be borne in mind when prescribing any drugs that are metabolised by it. 

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