How does hepatic impairment affect drug dosing and what general strategies minimize risk?

• A. Reduced hepatic metabolism; adjust doses or choose hepatically cleared alternatives.
• B. Hepatic impairment does not affect drug dosing.
• C. Reduced hepatic metabolism; adjust doses or choose hepatically cleared alternatives; monitor for toxicity; check liver function tests.
• D. Only renal clearance matters in dosing.

Answer: (C)

Hepatic impairment slows the liver’s ability to metabolize many drugs, so clearance decreases and drug exposure increases. This raises the risk of toxicity, especially for drugs with narrow therapeutic windows. To minimize risk, you reduce the dose or extend dosing intervals, and you prefer medications that are cleared by non-hepatic routes or by hepatic pathways that are less affected if possible. In addition, monitoring for toxicity and checking liver function tests help guide ongoing therapy and catch problems early. This combination—dose/interval adjustment, careful drug selection, and timely monitoring—addresses the way liver dysfunction changes drug exposure. The other ideas fall short because they imply no dosing effect, or they ignore the importance of liver clearance and testing in guiding safe treatment.