Information should be gathered about the history of liver impairment or the type of liver disease to enable a risk assessment and decisions about treatment.

Potential issues in liver impairment

Asking the right questions and gathering information is important because using medicines in patients with liver impairment can lead to issues such as hepatotoxicity, increased side effects and reduced therapeutic effects.

Even where mild liver impairment is suspected, liver blood tests should be monitored, and medications reviewed.

It is also important to be aware of the early, late and red flag symptoms of liver disease as they help to build a clinical picture of the extent of liver disease or dysfunction.

Red flags to refer

Consider an urgent referral if the patient has any of the following red flag symptoms:

  • fever with high temperatures and shivers, often caused by an infection
  • shortness of breath
  • vomiting blood
  • very dark or black tarry stools (faeces)
  • periods of mental confusion or drowsiness

Further information on the symptoms of liver disease is available from the British Liver Trust.

Advice for undertaking medication reviews

It is important to distinguish between liver disease, liver dysfunction and drug induced liver injury as these have different considerations when completing a medication review.

Where possible, the prescribing of all medicines, including the use of hepatotoxic medicines, should be kept to a minimum in all patients with severe liver disease.

Gathering information

Take a stepwise approach for gathering information when managing medicines in people with liver impairment.

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