Use of contraindicated drugs in patients with chronic liver disease: A therapeutic dilemma

摘要

Objective: To investigate the prevalence of prescribing of contraindicated drugs or those requiring caution, in hospital inpatients with chronic liver disease. Methods: The medical records and drug charts of adult hospitalized patients, consecutively admitted with clinical documentation and biochemical evidence of chronic liver disease, were studied retrospectively. Comparison was made between the prescription details for each drug and the recommendations for use in patients with liver disease under the approved product information, which indicates drugs that could be hepatotoxic and those that could have markedly altered pharmacokinetics or pharmacodynamics in chronic liver disease. Results: 49 eligible patients with both clinical documentation and confirmatory biochemical evidence of chronic liver disease were identified. Of these, 15 had received at least 1 contraindicated medication during hospitalization, with diazepam being the most common. 31 patients had received at least 1 drug which requires precaution in liver disease, with propranolol being the most common. Conclusion: The use of contraindicated drugs or those requiring caution, occurred frequently in hospital patients with chronic liver disease. This could reflect the somewhat limited evidence base and the perhaps overly cautious nature of the official product information.