Weersink R A, Drenth J P H, Ter Borg F, Mulder M B, Taxis K, Borgsteede S D
Deventer Ziekenhuis, afd. Klinische Farmacie, Deventer.
Contact: R.A. Weersink (
Ned Tijdschr Geneeskd. 2020 Oct 29;164:D4952.
The liver has a major role in the pharmacokinetics and pharmacodynamics of medicines and hepatic impairment could therefore lead to increased plasma levels and adverse drug reactions. Due to the large overcapacity of the liver, medication adjustments are only needed when a chronic liver disease has progressed to cirrhosis. Important pharmacokinetic alterations that could occur in cirrhosis are: (a) a decreased first-pass effect, (b) impaired metabolism by liver enzymes, and (c) in an advanced stage also impairment of renal elimination. Patients with cirrhosis could also be more sensitive to certain adverse drug reactions at normal drug levels, such as renal impairment due to NSAIDs or the sedative effect of morphinomimetics and psychotropic drugs. Prescribing in patients with cirrhosis is complex, which we illustrate by 5 common pitfalls. In practice, healthcare professionals could use a website with guidance for prescribing almost 300 medicines (www.geneesmiddelenbijlevercirrose.nl).
肝脏在药物的药代动力学和药效学中起主要作用，因此肝功能损害可能导致血浆药物水平升高和药物不良反应。由于肝脏有很大的储备能力，只有在慢性肝病进展为肝硬化时才需要调整用药。肝硬化时可能发生的重要药代动力学改变有：(a)首过效应降低；(b)肝酶代谢受损；(c)在晚期还会出现肾排泄受损。肝硬化患者在正常药物水平下也可能对某些药物不良反应更敏感，如非甾体抗炎药导致的肾功能损害或吗啡类药物和精神药物的镇静作用。给肝硬化患者开药很复杂，我们通过5个常见的误区来说明。在实践中，医疗保健专业人员可以使用一个提供近300种药物处方指南的网站(www.geneesmiddelenbijlevercirrose.nl)。
