Liver: Information sources

Last updated: Sunday, July 12, 2015

For clinical problems about prescribing in liver disease, there isn’t a one-stop reference source with all the answers; you’ll often need to search through several resources to try to build your answer. You might also need to consult some of the other Clinical Topics such as Adverse Reactions and Interactions.

Having said that, Drugs and the Liver by Penny North-Lewis (Pharmaceutical Press, 2008) has some really helpful chapters on choosing drug therapy in patients with liver disease including analgesics and antiemetics.

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The SPCs can be helpful in this respect too, and there may be guidance on dose in liver disease in the Posology section (4.2), but the nature of clinical trials is such that patients with more severe liver disease are often excluded, and so information may be lacking. In this case look in section 5.2 of an SPC (Pharmacokinetic Properties) which should explain whether the liver plays an important part in drug clearance. The manufacturer’s Medical Information department may have some extra information to that in their SPCs.

Literature searches in Embase and Medline may help. In addition to looking for published papers about prescribing of your drug in liver disease, think ‘big picture’ and find out how the disease is treated in patients without liver disease – you may find some alternatives you hadn’t considered.

Establish whether any expert bodies have issued general guidance for the condition your patient is suffering from. They will often cover treatment of a condition in otherwise healthy patients, and then provide treatment advice for special groups such as patients with liver disease. Alternatively specialist hepatology groups such as British Association for the Study of the Liver (BASL) or the European Association for the Study of the Liver (EASL) may have some information.

Don’t forget your local experts. Do you have a local gastroenterology or liver pharmacist? Or can you contact a local specialist doctor for advice?

Finally, general resources such as Martindale, Micromedex, and AHFS Drug Information can be helpful if you have them available locally.

Be careful about conducting a general internet search on this subject. If you do, you may like to look at our brief guide to evaluating websites about medicines.

Presenting Your Answer 

Once you’ve asked sufficient questions, gathered the information required and assessed it, you’ll need to provide an answer. As a reminder, we offer some general guidance on answering clinical problems. You might like to refresh your memory if you’ve not looked at this recently.