Dosage adjustment for hepatic dysfunction based on Child–Pugh scores

Approximately 2.5 million people have liver disease in the United States, accounting for 1.4% of the U.S. population.1 According to the Centers for Disease Control and Prevention, chronic liver disease and cirrhosis were the 12th leading cause of death in 2004.2 Several quantitative metabolic markers (e.g., antipyrine, galactose, monoethylglycine- xylide) can be used to assess hepatic function.3 While these tests can detect liver damage, the Child–Pugh classification system of alcoholic cirrhosis and portal hypertension is the clinical tool that is most often used for this purpose. It evaluates synthetic liver function using five markers: serum bilirubin, serum albumin, prothrombin time, the presence of encephalopathy, and the presence of ascites.4 Disease severity is then classified as mild (5 or 6 points), moderate (7–9 points), or severe (10–15 points). We aimed to develop a list of Child–Pugh dosing recommendations to aid clinicians in making appropriate dosage adjustments for patients with hepatic dysfunction.