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Prescribing for patients with liver damage


Many drugs are metabolised in the liver, and the duration and intensity of action of such drugs are increased in some patients with liver disease. However, many patients react normally to drugs, for although some mechanisms, such as the secretion of conjugated bilirubin into the bile, may be impaired, liver enzymes may continue to metabolise drugs normally. The function of liver microsomes is probably preserved because many drugs stimulate the synthesis of microsomal enzymes (enzyme induction), even in the failing liver,1 and thereby increase the metabolism of a variety of drugs. About 200 compounds have so far been shown to induce these enzymes.

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