Drug | Status | Comments |
Abacavir | Avoid in severe hepatic impairment | Avoid in moderate hepatic impairment unless essential |
Acetylsalicylic acid | Avoid in severe hepatic impairment | Increased risk of Gastrointestinal bleeding |
Allopurinol | Reduce the dose | |
Aluminium hydroxide | Avoid in severe hepatic impairment | Can precipitate hepatic encephalopathy by causing constipation; Antacids containing high amount of sodium to be avoided in patients with fluid retention |
Amidotrizoate | Use with caution | |
Amitryptyline | Avoid in severe hepatic impairment | Increased sedation |
Amlodipine | Reduce dose | Half life of amlodipine is prolonged |
Amodiaquine | Avoid in hepatic impairment | |
Amoxycillin + Clavulanic acid | Use with caution | Monitor liver function, cholestatic jaundice reported either during or shortly after therapy (more common in males and patients over 65 years), duration of treatment should not exceed 2 weeks |
Azathioprine | Reduce dose | |
Azithromycin | Avoid | May cause jaundice |
Bupivacaine | Avoid or reduce dose in severe hepatic impairment | |
Carbamazepine | Avoid in severe moderate to severe hepatic impairment | Cautiously given in mild hepatic impairment |
Ceftriaxone | Reduce dose and monitor plasma concentration if there is associated renal impairment | |
Chlorambucil |
Reduce dose and use cautiously in hepatic impairment |
|
Chloramphenicol |
Avoid if possible; reduce dose and monitor plasma concentration |
Increased risk of bone marrow depression |
Chlorpheniramine |
Avoid |
May cause inappropriate sedation |
Chlorpromazine |
Use with caution |
May precipitate coma |
Clindamycin |
Reduce dose |
|
Clomifene |
Avoid in severe hepatic impairment |
|
Clomipramine |
Avoid in severe hepatic impairment |
Increased sedation |
Cloxacillin |
Use with caution |
Cholestatic jaundice may occur up to several weeks after treatment has stopped; risk increases with increasing age and if given for more than 2 weeks |
Codeine |
Avoid or reduce dose |
May precipitate coma; Causes constipation |
Contraceptive, oral |
Avoid in case of active liver disease |
Avoid if history of cholestasis and pruritus during pregnancy |
Cyclophosphamide |
Reduce dose |
Monitor plasma level |
Cyclosporine |
Reduce dose and use with caution |
Hepatotoxic |
Cytarabine |
Reduce dose |
|
Dacarbazine |
Avoid in severe hepatic impairment |
Dose reduction in mild to moderate hepatic impairment |
Daunorubicin |
Reduce dose |
Use with caution as toxicity increases in hepatic impairment |
Diazepam |
Avoid in severe hepatic impairment |
Can precipitate coma |
Didanosine |
Monitor for toxicity |
|
Doxorubicin |
Reduce dose according to bilirubin concentration |
|
Doxycycline |
Avoid or use with caution |
|
Efavirenz |
Avoid in severe hepatic impairment |
Dose reduction and/or use with caution in mild to moderate hepatic impairment |
Enalapril |
Use with caution |
Closely monitor liver function in patients with hepatic impairment |
Ergometrine |
Avoid in severe hepatic impairment |
|
Erythromycin |
Avoid in severe hepatic impairment |
May cause idiosyncratic hepatotoxicity |
Ethinylestradiol |
Avoid |
See also Contraceptives, Oral |
Etoposide |
Avoid in severe hepatic impairment |
Increased risk of toxicity in case of hepatic impairment |
Fluconazole |
Use with caution |
Hepatotoxicity |
5-Fluorouracil |
Use with caution; dose reduction may be required |
|
Fluoxetine |
Reduce dose or administer on alternate days |
|
Fluphenazine |
Avoid in severe hepatic impairment |
Hepatotoxic, can precipitate coma |
Furosemide |
Avoid or use with caution in severe hepatic impairment |
Hypokalaemia may precipitate coma (use potassium sparing diuretic to prevent this); Increased risk of hypomagnesaemia in alcoholic cirrhosis |
Glibenclamide |
Avoid or reduce the dose |
Increased risk of hypoglycaemia; can produce jaundice |
Griseofulvin |
Avoid in severe hepatic impairment |
|
Haloperidol |
Use with caution |
Can precipitate coma |
Heparin |
Reduce dose in severe liver disease |
|
Hydralazine |
Reduce dose |
|
Hydrochlorothiazide |
Avoid in severe hepatic impairment |
Hypokalaemia may precipitate coma (use potassium sparing diuretic to prevent this); increased risk of hypomagnesaemia in alcoholic cirrhosis |
Ibuprofen |
Avoid in severe hepatic impairment |
Increased risk of gastrointestinal bleeding and can also cause fluid retention |
Indinavir |
Reduce dose to 600 mg 8th hly in mild to moderate hepatic impairment; not studied in severe hepatic impairment |
|
Isoniazid |
Use with caution |
Regularly monitor liver function and particularly frequently in first 2 months |
Levonorgestrel |
Use with caution in active liver disease and recurrent cholestatic jaundice |
|
Lidocaine |
Avoid or reduce the dose in severe hepatic impairment |
|
Magnesium hydroxide/sulphate |
Avoid in hepatic coma if risk of renal failure |
|
Medroxyprogesterone |
Avoid in active liver disease |
Avoid if history of pruritus and cholestasis during pregnancy |
Mefloquine |
Avoid for prophylaxis in severe liver disease |
|
6-Mercaptopurine |
May need dose reduction |
|
Metformin |
Avoid |
Withdraw if tissue hypoxia likely |
Methadone |
Avoid or reduce the dose |
May precipitate coma |
Methotrexate |
Avoid in severe hepatic impairment |
Hepatotoxic; monitor liver functions |
Methyldopa |
Avoid in active liver disease |
|
Metoclopramide |
Reduce dose |
|
Metronidazole |
Reduce total daily dose to one third and give once daily in case of severe hepatic impairment |
|
Morphine |
Avoid or reduce the dose |
May precipitate coma |
Nevirapine |
Avoid in severe hepatic impairment |
Use with caution in moderate hepatic impairment |
Nitrofurantoin |
Use with caution |
Cholestatic jaundice and chronic active hepatitis reported |
Norethisterone |
Avoid in active liver disease. |
Avoid if history of pruritus and cholestasis during pregnancy |
Ofloxacin |
Reduce dose in severe hepatic impairment |
Hepatic dysfunction reported |
Paracetamol |
Avoid large doses- dose related toxicity |
|
Phenobarbital |
Avoid in severe hepatic impairment |
May precipitate coma |
Phenytoin |
Reduce dose to avoid toxicity |
|
Prednisolone |
Use with caution |
Adverse effects more common |
Procainamide |
Avoid or reduce the dose |
|
Procarbazine |
Avoid in severe hepatic impairment |
|
Promethazine |
Avoid in severe hepatic impairment |
May precipitate coma; Hepatotoxic |
Propylthiouracil |
Reduce dose |
|
Pyrazinamide |
Avoid in severe hepatic impairment |
Monitor hepatic function- idiosyncratic hepatotoxicity more common |
Pyrimethamine |
Use with caution |
|
Ranitidine |
Reduce dose |
Increased risk of confusion |
Ribavirin |
Avoid in severe hepatic impairment |
|
Rifampicin |
Avoid or do not exceed 8 mg/kg daily |
Monitor liver function |
Saquinavir |
Avoid in severe hepatic impairment; Caution in moderate hepatic impairment |
|
Simvastatin |
Avoid in active liver disease or unexplained persistent elevation in serum transaminases |
|
Sodium nitroprusside |
Avoid in severe hepatic impairment |
|
Sulfadiazine |
Avoid in severe hepatic impairment |
|
Sulfamethoxazole + trimethoprim |
Avoid in severe hepatic impairment |
|
Suxamethonium |
|
Prolonged apnoea may occur in severe liver disease due to reduced hepatic synthesis of plasma cholinesterase |
Testosterone |
Preferably avoid |
Possibility of dose related toxicity and fluid retention |
Thiopental |
Reduce dose in severe liver disease |
|
Valproic acid |
Avoid, if possible |
Hepatotoxicity and hepatic failure may occasionally occur (usually in first 6 months) |
Verapamil |
Reduce oral dose |
|
Vinblastine |
Reduction of dose may require |
|
Vincristine |
Reduction of dose may require |
|
Warfarin |
Avoid in severe liver disease |
Reduced production of clotting factors in hepatic impairment; may increase risk of bleeding |
Zudovudine |
Reduction of dose as accumulation may occur |
|