Follath F
Schweiz Med Wochenschr. 1986 Apr 26;116(17):549-52.
Most analgesics, antiarrhythmics, antiepileptics, theophylline and sedatives are inactivated by hepatic biotransformation. The use of these drugs in intensive care patients with abnormal liver function may be difficult because no reliable laboratory tests are available to predict the pharmacokinetic changes. Measurement of serum drug levels is the best method for individualized dosage adaptation, but the possibilities of routine drug monitoring are limited. To avoid toxic drug accumulation, agents with predominantly renal elimination should be selected. If no such alternatives exist, treatment should be initiated in a reduced dose and then modified according to the pharmacological effects observed.
大多数镇痛药、抗心律失常药、抗癫痫药、茶碱和镇静剂都会通过肝脏生物转化而失活。对于肝功能异常的重症监护患者，使用这些药物可能会有困难，因为没有可靠的实验室检测方法来预测药代动力学变化。测定血清药物水平是实现个体化剂量调整的最佳方法，但常规药物监测的可能性有限。为避免药物毒性蓄积，应选择主要经肾脏排泄的药物。如果没有此类替代药物，则应从小剂量开始治疗，然后根据观察到的药理作用进行调整。
