Which action is recommended when dosing medications in hepatic impairment?

• A. Increase dose
• B. Do nothing
• C. Adjust dose or dosing interval; monitor liver function tests for hepatotoxicity
• D. Switch to renal dosing

Answer: (C)

When liver function is impaired, the body's ability to metabolize many medications decreases, which can raise drug exposure and the risk of toxicity. The best approach is to tailor therapy by adjusting the dose or extending the dosing interval based on how severe the impairment is and the drug’s hepatic clearance, along with monitoring liver function tests for hepatotoxicity. This allows the medication to stay within the therapeutic range while reducing the chance of accumulating toxic levels. Increasing the dose would worsen toxicity, doing nothing ignores the impairment, and switching to renal dosing isn’t generally appropriate because the issue is reduced hepatic metabolism rather than kidney excretion, unless specific drug data indicate a renal-cleared alternative is appropriate.