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Dosage adjustment in patients with hepatic disease Return to Top

Dosage adjustment may be required in the presence of hepatic disease for the following medications (consult FDA package insert for details):

Antimicrobial Agent	Category	Recommendation
Abacavir	Antiviral agent	A dose of 200 mg abacavir administered twice daily is recommended for patients with mild liver disease. The safety, efficacy, and pharmacokinetics of abacavir have not been studied in patients with moderate or severe hepatic impairment; therefore, abacavir is contraindicated in these patients.
Atazanavir	Antiviral agent	Mild hepatic impairment (Child-Pugh class A): 400 mg once daily Moderate hepatic impairment (Child-Pugh class B): 300 mg once daily Severe hepatic impairment (Child-Pugh class C): not recommended
Caspofungin	Antifungal agent	Mild hepatic impairment (Child-Pugh score 5 to 6): a dosage adjustment is not required Moderate hepatic impairment (Child-Pugh score 7 to 9): 35 mg once daily following a 70-mg loading dose on day 1 Severe hepatic impairment (Child-Pugh score >9): no clinical experience available Pediatric patients with any degree of hepatic impairment: no clinical experience available
Chloramphenicol	Antibacterial agent	Adults with impairment of hepatic function may have reduced ability to metabolize and excrete the drug. In instances of impaired metabolic processes, dosages should be adjusted accordingly. Precise control of concentration of the drug in the blood should be carefully followed in patients with impaired metabolic processes by the available microtechniques.
Clindamycin	Antibacterial agent	This product contains benzyl alcohol as a preservative and has been associated with gasping syndrome in pediatric patients. The risk of benzyl alcohol toxicity depends on the quantity administered and the hepatic capacity to detoxify the chemical.
Darunavir-Ritonavir	Antiviral agent	No dose adjustment of Darunavir/ritonavir is necessary for patients with either mild or moderate hepatic impairment. No pharmacokinetic or safety data are available regarding the use of Darunavir/ritonavir in subjects with severe hepatic impairment. Therefore, Darunavir/ritonavir is not recommended for use in patients with severe hepatic impairment.
Delavirdine
Efavirenz
Enfuvirtide
Fosamprenavir
Fusidic acid
Indinavir
Isoniazid
Itraconazole
Lopinavir-Ritonavir
Metronidazole
Nafcillin
Nelfinavir
Nevirapine
Quinupristin-Dalfopristin
Rifabutin
Rifampin
Rimantadine
Ritonavir
Telithromycin
Tigecycline
Tinidazole
Voriconazole