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Potential drug-drug interactions and adverse drug reactions in patients with liver cirrhosis

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Background and aims

Patients with liver cirrhosis may be at risk for potential drug-drug interactions (pDDIs) and/or adverse drug reactions (ADRs) due to the severity of their disease and comorbidities associated with polypharmacy.

Methods

We performed a cross-sectional retrospective study including 400 cirrhotic patients and assessed diagnoses, medication patterns, pDDIs, and ADRs at hospital admission.

Results

The median (range) age of the patients was 60 (21–88) years; 68.5% were male. They had a total of 2,415 diagnoses, resulting in 6 (1–10) diagnoses per patient. Frequent were diagnoses of the digestive system (28.4%), circulatory system (14.2%), blood and blood-forming organs (8.7%), and psychiatric disorders (7.5%); 60.7% of the diagnoses were not liver-associated. The median number of drugs per patient was 5 (0–18), whereof 3 (0–16) were predominantly hepatically eliminated. Drugs were primarily indicated for gastrointestinal, cardiovascular, or nervous system disorders, reflecting the prevalent diagnoses. In 112 (28%) patients, 200 ADRs were detected, mainly associated with spironolactone, torasemide, furosemide, and ibuprofen. In 86 (21.5%) patients, 132 pDDIs were detected. Seven of these pDDIs were the direct cause of 15 ADRs, whereof 3 resulted in hospital admission. Patients with ADRs were older, had more comorbidities, were treated with more drugs, and had a worse renal function and more pDDIs than patients without ADRs.

Conclusions

Pharmacotherapy is complex in cirrhotic patients. Hepatologists should know the principles of dose adjustment in cirrhosis and renal failure, but also the most important pDDIs of the drugs used to treat liver disease and comorbidities in this population.

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Abbreviations

pDDIs:

Potential drug-drug interactions

ADRs:

Adverse drug reactions

NSAIDs:

Nonsteroidal anti-inflammatory drugs

Q0 :

Extrarenal elimination fraction

ATC code:

Anatomical Therapeutic Chemical Classification System

ACE:

Angiotensin-converting enzyme

HSCT:

Hematopoietic stem cell transplantation

RAAS:

Renin angiotensin aldosterone system

SSRI:

Selective serotonine reuptake inhibitor

COX:

Cyclooxygenase

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Conflict of interest

None of the authors indicates a conflict of interest with this work.

Financial support

S.K. is supported by the Swiss National Science Foundation (31003A_132992/1).

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Authors and Affiliations

  1. Division of Clinical Pharmacology and Toxicology, University Hospital, 4031, Basel, Switzerland

    Carmen C. Franz, Sabin Egger, Christa Born, Alexandra E. Rätz Bravo & Stephan Krähenbühl

  2. Regional Pharmacovigilance Center, University Hospital, Basel, Switzerland

    Alexandra E. Rätz Bravo

Authors
  1. Carmen C. Franz
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  2. Sabin Egger
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  3. Christa Born
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  4. Alexandra E. Rätz Bravo
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  5. Stephan Krähenbühl
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Corresponding author

Correspondence to Stephan Krähenbühl.

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Franz, C.C., Egger, S., Born, C. et al. Potential drug-drug interactions and adverse drug reactions in patients with liver cirrhosis. Eur J Clin Pharmacol 68, 179–188 (2012). https://doi.org/10.1007/s00228-011-1105-5

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  • DOI: https://doi.org/10.1007/s00228-011-1105-5

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