DOSING IN LIVER DISEASE

For severe liver dysfunction (albumin<30g/L, INR > 1.2):

(a) If the drug is a high clearance drug (liver blood flow-dependent) - - >
reduce dose by 50%:

High Clearance Drugs:

Antipsychotics Nitrates

Beta-blockers (most) Opioids (most)

Calcium channel blockers SSRIs

Lignocaine Statins

Tricyclic antidepressants

(b) If the drug is low clearance (flow-independent – includes all other

metabolised drugs) - ->reduce dose by 25%:

Low Clearance Drugs: (examples)

Amiodarone Quinidine

Anticonvulsants (most) Retinoids

Antimalarials Rifampicin

Antiparkinsons (except amantadine) Spironolactone

Antithyroid Steroids

Benzodiazepines Sulphonylureas

NSAIDs Theophylline

Proton pump inhibitors Warfarin

Paracetamol