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Drugs to avoid in liver failure 💊
⚠️ Be very cautious when prescribing or combining the following drugs, especially in frail, elderly, or comorbid patients. Always cross-check the 💊 BNF for interactions and dosing.
🚦 Common High-Risk Drug Groups
| 💊 Drugs | ⚠️ Details / Risks |
|---|---|
| Opiates / Codeine | ↑ Sedation, respiratory depression, constipation.
💡 Use lowest effective dose, avoid combining with other CNS depressants. |
| Benzodiazepines | ↑ Sedation, falls, confusion.
💡 Avoid co-prescription with opioids unless palliative setting. |
| Diuretics | Risk of dehydration, electrolyte imbalance (low Na⁺, K⁺), and AKI.
💡 Monitor U&Es regularly. |
| Anticoagulants | ↑ Risk of major bleeding.
💡 Especially dangerous with NSAIDs, steroids, or antiplatelets. |
| Antiplatelets | ↑ Risk of GI bleeding, particularly in dual therapy or with anticoagulants.
💡 Consider PPI co-prescription. |
| NSAIDs | Risk of GI bleed, AKI, and fluid retention.
💡 Avoid in heart failure, renal impairment, or when combined with ACEi + diuretic (triple whammy). |
| Steroids | ↑ Risk of infection, hyperglycaemia, osteoporosis, and fluid retention.
💡 Warn patients and use lowest dose possible. |
| Paracetamol | Generally safe, but overdose risk (esp. in frail/liver disease).
💡 Ensure max daily dose = 4 g (8 x 500 mg tablets). |
💡 Teaching Pearls
- 👵 Older adults are particularly vulnerable due to polypharmacy and reduced clearance.
- 🧮 Always review renal function (U&Es) and liver function when starting or combining drugs.
- 📌 The “Triple Whammy” (ACEi/ARB + diuretic + NSAID) is a classic cause of AKI – avoid unless essential.
- 🩸 If dual antiplatelet therapy or anticoagulants are required, always check bleeding risk scores (e.g., HAS-BLED) and GI protection.
- 🔄 Deprescribing (stopping unnecessary meds) is just as important as prescribing.
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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