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Dose adjustments in hepatic impairment are highly variable. Always consult drug-specific prescribing information and clinical pharmacology resources. This calculator provides general guidance only.
Calculate Child-Pugh score and dose adjustments for hepatic impairment
| Parameter | 1 Point | 2 Points | 3 Points |
|---|---|---|---|
| Encephalopathy | None | Grade 1-2 | Grade 3-4 |
| Ascites | None | Mild | Moderate-Severe |
| Bilirubin (mg/dL) | <2 | 2-3 | >3 |
| Albumin (g/dL) | >3.5 | 2.8-3.5 | <2.8 |
| INR | <1.7 | 1.7-2.3 | >2.3 |
Well-compensated disease
1-year survival: 100%
Significant functional compromise
1-year survival: 80%
Decompensated disease
1-year survival: 45%
The liver metabolizes many drugs. In hepatic impairment, drug metabolism is reduced, protein binding may be altered (due to low albumin), and portal-systemic shunting can increase drug bioavailability. This can lead to drug accumulation and toxicity.
Drugs with high hepatic extraction (propranolol, morphine, verapamil) and those extensively metabolized by CYP450 enzymes need adjustment. Drugs eliminated renally may not need adjustment unless liver disease affects kidney function.
Hepatic encephalopathy is brain dysfunction caused by liver failure. Grade 1-2 includes subtle changes like altered sleep, mild confusion. Grade 3-4 includes marked confusion, stupor, or coma. It indicates severe liver dysfunction.
Albumin binds many drugs. Low albumin in liver disease increases the free (active) drug fraction, potentially increasing both therapeutic and toxic effects. Highly protein-bound drugs are particularly affected.
No. These are general guidelines. Actual dose adjustments depend on the specific drug, its therapeutic index, the patient's clinical status, and available monitoring. Always consult drug-specific resources and consider clinical pharmacology consultation.
Hepatotoxic drugs, high first-pass metabolism drugs at full doses, and sedatives (which can precipitate encephalopathy) should be avoided or used with extreme caution in Child-Pugh C patients.