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Dose Recommendations for Common Drugs in Patients with Liver Cirrhosis: A Systematic Literature Review
BACKGROUND AND OBJECTIVES: The presence of liver cirrhosis affects the selection and dosing of drugs metabolised by the liver as doses have to be adjusted to the remaining liver function. This is a major challenge in clinical practice as specific guidelines are lacking. The aim of this study was to...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10374753/ https://www.ncbi.nlm.nih.gov/pubmed/37460783 http://dx.doi.org/10.1007/s40261-023-01289-0 |
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author | Karsten Dafonte, Katharina Weber, Lisa Chmielewski, Florian Böhmer, Anna Maria Lutz, Philipp Hartmann, Gunther Jaehde, Ulrich Coenen, Martin |
author_facet | Karsten Dafonte, Katharina Weber, Lisa Chmielewski, Florian Böhmer, Anna Maria Lutz, Philipp Hartmann, Gunther Jaehde, Ulrich Coenen, Martin |
author_sort | Karsten Dafonte, Katharina |
collection | PubMed |
description | BACKGROUND AND OBJECTIVES: The presence of liver cirrhosis affects the selection and dosing of drugs metabolised by the liver as doses have to be adjusted to the remaining liver function. This is a major challenge in clinical practice as specific guidelines are lacking. The aim of this study was to identify drugs for which recommendations on selection and dose adjustments for patients with cirrhosis exist by assessing the literature according to certain quality standards, paying particular attention to the suitability of these recommendations for clinical practice. METHODS: A systematic literature review included peer-reviewed publications that were published by October 2020 in PubMed in the English language and aimed to generate recommendations on dose adjustment in patients with liver cirrhosis. Subsequently, the identified publications were checked for reporting quality against the relevant reporting guidelines and the Oxford Centre for Evidence-Based Medicine Levels of Evidence. Finally, all specific dose recommendations were extracted, compared with the specifications of the Summaries of Product Characteristics and mapped according to the Anatomical Therapeutic Chemical/Defined Daily Dose Index. RESULTS: Eighteen publications covering a total of 1145 dose recommendations for 481 active substances were identified. There were 706 recommendations for 316 substances sufficiently specific for application in clinical practice. For 22 active substances, the specific recommendations were consistent across multiple publications, of which only six were also consistent with the respective Summaries of Product Characteristics. CONCLUSIONS: As the majority of dose recommendations were not sufficiently specific or even contradictory, there is an urgent need for the definition of standard parameters for a uniform assessment of drugs in liver cirrhosis. In addition, dose recommendations should be aligned by suitable methods. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40261-023-01289-0. |
format | Online Article Text |
id | pubmed-10374753 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-103747532023-07-29 Dose Recommendations for Common Drugs in Patients with Liver Cirrhosis: A Systematic Literature Review Karsten Dafonte, Katharina Weber, Lisa Chmielewski, Florian Böhmer, Anna Maria Lutz, Philipp Hartmann, Gunther Jaehde, Ulrich Coenen, Martin Clin Drug Investig Systematic Review BACKGROUND AND OBJECTIVES: The presence of liver cirrhosis affects the selection and dosing of drugs metabolised by the liver as doses have to be adjusted to the remaining liver function. This is a major challenge in clinical practice as specific guidelines are lacking. The aim of this study was to identify drugs for which recommendations on selection and dose adjustments for patients with cirrhosis exist by assessing the literature according to certain quality standards, paying particular attention to the suitability of these recommendations for clinical practice. METHODS: A systematic literature review included peer-reviewed publications that were published by October 2020 in PubMed in the English language and aimed to generate recommendations on dose adjustment in patients with liver cirrhosis. Subsequently, the identified publications were checked for reporting quality against the relevant reporting guidelines and the Oxford Centre for Evidence-Based Medicine Levels of Evidence. Finally, all specific dose recommendations were extracted, compared with the specifications of the Summaries of Product Characteristics and mapped according to the Anatomical Therapeutic Chemical/Defined Daily Dose Index. RESULTS: Eighteen publications covering a total of 1145 dose recommendations for 481 active substances were identified. There were 706 recommendations for 316 substances sufficiently specific for application in clinical practice. For 22 active substances, the specific recommendations were consistent across multiple publications, of which only six were also consistent with the respective Summaries of Product Characteristics. CONCLUSIONS: As the majority of dose recommendations were not sufficiently specific or even contradictory, there is an urgent need for the definition of standard parameters for a uniform assessment of drugs in liver cirrhosis. In addition, dose recommendations should be aligned by suitable methods. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40261-023-01289-0. Springer International Publishing 2023-07-18 2023 /pmc/articles/PMC10374753/ /pubmed/37460783 http://dx.doi.org/10.1007/s40261-023-01289-0 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by-nc/4.0/Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Systematic Review Karsten Dafonte, Katharina Weber, Lisa Chmielewski, Florian Böhmer, Anna Maria Lutz, Philipp Hartmann, Gunther Jaehde, Ulrich Coenen, Martin Dose Recommendations for Common Drugs in Patients with Liver Cirrhosis: A Systematic Literature Review |
title | Dose Recommendations for Common Drugs in Patients with Liver Cirrhosis: A Systematic Literature Review |
title_full | Dose Recommendations for Common Drugs in Patients with Liver Cirrhosis: A Systematic Literature Review |
title_fullStr | Dose Recommendations for Common Drugs in Patients with Liver Cirrhosis: A Systematic Literature Review |
title_full_unstemmed | Dose Recommendations for Common Drugs in Patients with Liver Cirrhosis: A Systematic Literature Review |
title_short | Dose Recommendations for Common Drugs in Patients with Liver Cirrhosis: A Systematic Literature Review |
title_sort | dose recommendations for common drugs in patients with liver cirrhosis: a systematic literature review |
topic | Systematic Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10374753/ https://www.ncbi.nlm.nih.gov/pubmed/37460783 http://dx.doi.org/10.1007/s40261-023-01289-0 |
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