Practice points

Prescribing in liver disease

• Use hepatotoxic drugs with caution.
• Aim to use short acting drugs.
• Start with a small dose and increase slowly or as required.
• Monitor response to titrations closely (for example analgesic control).
• Consider overall goals of care, mindful of prognosis.

Specific considerations

• Hepatic encephalopathy:be aware of increased sensitivity to sedatives, hypnotics and central nervous system depressants; use caution when prescribing constipating agents.
• Be vigilant for concurrent renal impairment and prescribe accordingly.
• In patients with a low albumin: be mindful of prescribing drugs that are highly protein bound (such as warfarin, anticoagulants, oral antidiabetics).