Science to Practice
Latest highlights on drug safety and efficacy

7.10.2026

Patients with liver cirrhosis often require dose adjustments due to altered drug pharmacokinetics, but clear and consistent dosing guidance is frequently lacking. In a recent multidisciplinary study, 12 experts in hepatology, clinical pharmacology and clinical pharmacy evaluated drug selection and dose adjustment across Child-Pugh classes A–C.

Consensus or strong consensus was reached for only 20% of 177 recommendations. Agreement decreased markedly with increasing severity of liver disease, from 83% in Child-Pugh A to 47% in Child-Pugh B and 41% in Child-Pugh C.

Of the 36 recommendations for which consensus was reached, only 18 were fully consistent with the corresponding Summary of Product Characteristics.

The findings highlight the uncertainty surrounding pharmacotherapy in liver cirrhosis and the need for harmonised, stage-specific dosing guidance integrating pharmacokinetic evidence, prescribing information and clinical expertise.

Dosing guidance in liver cirrhosis remains inconsistent, particularly in more severe disease, highlighting the need for harmonised, stage-specific recommendations.

For more comprehensive information, explore Heparbase, our specialised database providing detailed insights on drug safety and efficacy when treating patients with hepatic impairment.

News produced by Medbase Medical Team

References

1. Karsten Dafonte K, Lutz P, Jansen C, et al. Recommendations on Drug Selection and Dose Adjustment for Patients with Liver Cirrhosis: Results from a Multidisciplinary Expert Panel. Clin Drug Investig. 2026;46:377–390. doi:10.1007/s40261-026-01536-0. PMID: 41806204.