Journal: Drug Invention Today

Article Id: JPRS-P'Col-00005027
Title: Review on impact of drugs with high hepatic extraction ratio on liver dysfunction
Category: Pharmacology
Section: Review Article
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    Liver dysfunction is a clinical syndrome in which liver is unable to perform its normal metabolic function. The hepatic extraction ratio of the drug is the ratio of hepatic clearance of a drug to the hepatic blood flow. First pass metabolism is the phenomenon, where the dug concentration is greatly reduced before it reaches the systemic circulation, whereas in liver dysfunction results in increased bioavailability and adverse effects. The first pass metabolism of drug decreases in liver dysfunction, thereby affects bioavailability by changing metabolizing enzyme activity, plasma protein binding, and creating intra and extrahepatic portacaval shunts. Oral drugs that are completely absorbed into portal circulation and its bioavailability depend on extraction ratio. When a drug with high hepatic extraction ratio (>0.7) has low bioavailability in healthy. Dosage adjustment in liver dysfunction can be done by causality scales like Child-Pugh, model of end-stage liver disease, and National Cancer Institute index and Roussel Uclaf Causality assessment method. Since liver metabolizes most of the drugs that have been taken orally, drug therapy can be rationalized by accounting its pharmacokinetics, severity of liver disease, and changes in end organ response that occur in the presence of liver dysfunction. The most dangerous drugs in patients with liver dysfunction are those with a high, low hepatic extraction, and a narrow therapeutic range, both initial and maintenance doses have to be adjusted by >50% of the normal dose. Hence, studies should be carried out to find the correlation between hepatic extraction ratio of prescribed drugs in patients with liver dysfunction.

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    Author(s) Name:

    M. Lalitha Laxhmi, A. Priyadharshini*, S. P. Ahalya

    Affiliation(s) Name:

    Department of Pharmacy Practice, SRM College of Pharmacy, SRM Institute of Science and Technology, Chennai, Tamil Nadu, India.


    *Corresponding author: A. Priyadharshini, Department of Pharmacy Practice, SRM College of Pharmacy, SRMIST, Chennai, Tamil Nadu, India.

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    Author:

    M. Lalitha Laxhmi, A. Priyadharshini*, S. P. Ahalya

    Title:Review on impact of drugs with high hepatic extraction ratio on liver dysfunction
    Journal:Drug Invention Today
    Vol(issue):14 (May)
    Year:2020
    Page No: (702-706)
  • Experimental Methods Keywords

    Methodology:Bioavailability, Dosage adjustment, Hepatic extraction ratio, Liver dysfunction
    Research Materials:Oral Drugs

Keywords

Bioavailability Dosage adjustment Hepatic extraction ratio Liver dysfunction

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