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Werni, A.
Schmerztherapie bei Leberinsuffizienz
[ Diplomarbeit/Master Thesis ] Medical University of Graz; 2011. pp.51. [OPEN ACCESS]
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Autor*innen der Med Uni Graz:
Betreuer*innen:: Bornemann-Cimenti Helmar; Sandner-Kiesling Andreas
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Abstract:: Pain medication in patients with severe illness is a clinical challenge. The liver plays an important role in the metabolism of drugs. Liver disease alters the hepatic blood flow, the intrinsic clearance, the amount of plasma proteins and drug binding to plasma proteins and the end-organ response. A systematic search was performed to identify pharmacokinetic alterations in liver diseases and dosage guidelines. Remifentanil, pregabalin and gabapentin are not metabolised in the liver, therefore no dosage adjustments are necessary. Diclofenac, ibuprofen, meloxicam, fentanyl and sufentanil are primary recommended and should be used carefully. Dosage of nimesolide, etoricoxib, celecoxib, paracetamol, alfentanil, dihydrocodeine, hydromorphone, methadone, morphine, oxycodone, pethidine, piritramide and tramadol must be reduced. Codeine, tilidine, carbamazepine and valproate acid should be avoided. Metamizole, rofecoxib, buprenorphine, nalbuphine, oxymorphone, amitriptyline, duloxetine, lamotrigine, topiramate, corticosteroids, ketamine and cannabinoids are not well studied and require further investigation. The existing data is often not precise and hardly comparable, therefore the recommendations should always be adjusted to the individual patients needs.