With hepatic impairment

Ketoconazole is contraindicated in patients with known hypersensitivity to the drug. Ketoconazole is used cautiously in patients with hepatic impairment, those who are pregnant (Category C), and during lactation. The absorption of ketoconazole is impaired when the drug... 

The proton pump inhibitors are contraindicated in patients who have hypersensitivity to any of the drags. Omeprazole (Pregnancy Category C) and lansoprazole, rabeprazole, and pantoprazole (Pregnancy Category B) are contraindicated during pregnancy and lactation. The proton pump inhibitors are used cautiously in older adults and in patients with hepatic impairment. 

Decrease dose in patients with hepatic impairment. 

Entacapone (Comtan ) Peripherally blocks COMT metabolism of DA Take a 200-mg tab with each Sinemet dose up to 8 tabs daily usual MD is 200 mg 3-4 times daily decrease dose by 50% with hepatic impairment... 

Rescriptor tabs mg tabs can be dispersed in greater than or equal to 3 oz of water to produce slurry) 200 mg tabs should be administered whole separate dosing from buffered DDI or antacids by 1 hour with hepatic impairment LFTs, headaches cytochrome P-450 (CYP) CYP3A inhibitor 51% excreted in urine (less than 5% unchanged) 44% in feces... 

Use with caution in patients No food restrictions with hepatic impairment... 

Prezista RTV 1 00 mg twice daily patients with hepatic impairment with food moiety, Stevens Johnson erythema multiforum have been reported) diarrhea, nausea headache hyperlipidemia transaminase elevation hyperglycemia fat maldistribution possible increased bleeding episodes in patients with hemophilia substrate... 

Fosamprenavir (fAPV) Lexiva 700-mg tabs ARV-na ive pts fAPV 1,400 mg bid or fAPV 700 mg + RTV 1 00 mg bid PS-experienced pts fAPV 700 mg + RTV 1 00 mg bid Co-admin is tra tion w/EFV fAPV 700 mg + RTV 1 00 mg bid or fAPV 1400 mg + RTV 300 mg qday Child-Pugh Dose Class 5-8 700 mg bid 9-12 Not recommended Ritonavir should not be used in patients with hepatic impairment None Skin rash diarrhea, nausea and vomiting headache hyperlipidemia LFT elevation hyperglycemia fat maldistribution increased bleeding episodes in patients with hemophilia CYP3A4 inhibitor, inducer, and substrate... 

LPV/r) Kaletra RTV 50 mg tablet, LPV 400 mg + RTV 1 00 mg/5 mL oral solution (contains 42% alcohol) bid 4 tablets qday With EFV or NVP 3 tablets or 6.7 mL bid with hepatic impairment T 48-80%) asthenia hyperlipidemia LFT elevation hyperglycemia fat maldistribution increased bleeding episodes in hemophiliacs and susbstrate... 

Viracept tabs, 50 mg/g oral powder 750 mg tid with hepatic impairment snack hyperglycemia fat maldistribution increased bleeding in hemophiliacs LFT elevation and substrate... 

Zolpidem is an imidazopyridine but not a benzodiazepine however, it acts on the same receptors as benzodiazepines. Zolpidem has a short duration of action and is indicated for patients who have difficulty sleeping. It does not have any hangover effects. The dose of Zolpidem should be reduced in patients with hepatic impairment and it should be avoided in cases of severe hepatic impairment. 

The dose of drugs metabolized by hepatic microsomal enzymes with low therapeutic ratios, or being given to patients with hepatic impairment, may require adjustment to maintain optimal therapeutic blood levels when starting or stopping concomitant therapy with ticlopidine. 

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. 

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

Renal/Hepatic function impairment Use with caution and in reduced doses in patients with hepatic impairment metabolism may be impaired, leading to drug accumulation. Use with caution in patients with significantly impaired renal function. Elderly Be cautious in dose selection for an elderly patient, usually starting at the low end of the dosing range. Elderly patients may be sensitive to the anticholinergic side effects of TCAs. 

Elderly/Hepatic function impairment- 20 mg/day is the recommended dose for most elderly patients and patients with hepatic impairment, with titration to 40 mg/day only for nonresponding patients. 

In subjects with hepatic impairment, clearance of racemic citalopram was decreased and plasma concentrations were increased. The recommended dose of escitalopram in hepatically impaired patients is 10 mg/day. 

Special populations - Consider a slower rate of dose titration and a lower target dose in the elderly, patients with hepatic impairment, debilitated patients, or those who have a predisposition to hypotensive reactions. Perform dose escalation with caution. 

Hepatic function impairment- Start patients with hepatic impairment on 25 mg/day. Increase the dose daily in increments of 25 to 50 mg/day to an effective dose, depending on the clinical response and tolerability of the... 

Special populations Use a starting dose of 6 mg/25 mg for patients with a predisposition to hypotensive reactions, patients with hepatic impairment, or patients who exhibit a combination of factors that may slow the metabolism of olanzapine/fluoxetine (eg, female gender, elderly, nonsmoking status). When indicated, perform dose escalation with caution in these patients. Olanzapine/fluoxetine has not been systemically studied in patients older than 65 years of age or in patients younger than 18 years of age. 

Hepatic function impairment No dose adjustment is needed for patients with hepatic impairment. 

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. 

Hepatic function //T pa/m enf.- Treat patients with hepatic impairment with caution. 

Use bupropion with caution in patients with hepatic impairment (including mild to moderate hepatic cirrhosis) and consider a reduced frequency of dosing in patients with mild to moderate hepatic cirrhosis (see Warnings). 

Hepatic function impairment Nelfinavir is principally metabolized by the liver. Exercise caution when administering this drug to patients with hepatic impairment. Pregnancy Category B. 

Hepatic function impairment Amprenavir is principally metabolized by the liver exercise caution when administering this drug to patients with hepatic impairment. Carcinogenesis Results showed an increase in the incidence of benign hepatocellular adenomas and an increase in the combined incidence of hepatocellular adenomas plus carcinoma in males of both species at the highest doses tested. 

Dose adjustment Do not prescribe abacavir/lamivudine to patients requiring dosage adjustment such as those with Ccr less than 50 mL/min, those with hepatic impairment, or those experiencing dose-limiting adverse events. 

Liver function /mpa/rmenf.-Abacavir is contraindicated in patients with moderate to severe hepatic impairment, and dose reduction is required in patients with mild hepatic impairment. Because abacavir/lamivudine is a fixed-dose combination and cannot be dose adjusted, abacavir/lamivudine is contraindicated for patients with hepatic impairment. 

Hepatic function impairment Exercise caution when administering fosamprenavir to patients with hepatic impairment. Patients with impaired hepatic function receiving fosamprenavir without concurrent ritonavir may require dose reduction. 

Monitoring Monitor whole blood sirolimus concentrations in patients receiving concentration-controlled sirolimus. Monitoring is also necessary in patients likely to have altered drug metabolism, in patients at least 13 years of age who weigh less than 40 kg, in patients with hepatic impairment, and during coadministration of potent CYP3A4 inducers and inhibitors. 

Acute leukemia/myelodysplasia Topo somerase II inhibitors, including mitoxantrone, have been associated with the development of acute leukemia and myelodysplasia. Hepatic function impairment Patients with severe hepatic dysfunction have an AUC more than 3 times greater than that of patients with normal hepatic function receiving the same dose. Administer mitoxantrone with caution to other patients with hepatic impairment a dosage adjustment may be required. 

Not recommended for those with severe renal and hepatic disease. E, enterohepatic cycling F, extensive first pass metabolism h, dosage adjustment may be necessary in patients with hepatic impairment H, dosage adjustment recommended for patients with hepatic impairment R, dosage adjustment necessary for patients with renal impairment. 

The reduction in therapeutic effectiveness that can occur when antihistamines are given for long periods is probably related to an induction of hepatic drug-metabolizing enzymes. Children tend to eliminate antihistamines more rapidly than adults, while individuals with hepatic impairment may eliminate them more slowly. 

Ribavirin is contraindicated in patients with sickle cell anemia and other hemoglobinopathies because of its propensity to cause anemia. Similarly, persons with coronary disease should not use ribavirin, because anemia may cause deterioration of cardiac function. Oral ribavirin should not be given to individuals with severe renal impairment no dosage adjustment is necessary for the inhaled formulation. However, patients with hepatic impairment may require dosage adjustment. 

Caution should be exercised when zidovudine is administered to patients with preexisting anemia or neutropenia and to those with advanced cases of AIDS. Dosage adjustment is required for patients with significant renal impairment and may also be necessary in those with hepatic impairment. 

ADH, alcohol dehydrogenase F+, food (high-fat meal) increases absorption F—, food interferes with absorption FPM, extensive first pass metabolism GT, glucuronyl transferase H , dosage adjustment in patients with hepatic impairment has not been studied ND, not determined R, dosage adjustment is necessary in patients with renal impairment. 

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