What dosing considerations are used when hepatic impairment is present?

• A. Ignore hepatic function.
• B. Evaluate bilirubin and transaminases; consider dose reductions or schedule alterations; adjust based on Child-Pugh or common guidelines.
• C. Increase dose to overcome impairment.
• D. Use the same dose regardless of impairment.

Answer: (B)

Hepatic impairment changes how a drug is metabolized and cleared, so dosing must be guided by liver function rather than assumed to be the same as in a healthy liver. The best approach is to assess liver function using laboratory values such as bilirubin and transaminases and to gauge severity with a scoring system like Child-Pugh, then adjust the dose or dosing schedule based on guidelines or drug-specific recommendations. Reducing dose, lengthening the interval between doses, or choosing an alternative when necessary helps prevent excessive exposure and toxicity while maintaining efficacy. Ignoring hepatic function, increasing the dose, or using the same dose regardless of impairment can lead to unsafe drug levels and harm.