Medication Safety in Patients with Liver Disease

A special issue of Pharmaceuticals (ISSN 1424-8247). This special issue belongs to the section "Pharmaceutical Technology".

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 5567

Special Issue Editors

Department of Clinical Decision Support, Health Base Foundation, Houten, The Netherlands
Interests: medication safety; clinical decision support; cirrhosis; clinical pharmacology
Gastroenterology & Hepatology Department | Pharmacy Department, Princess Alexandra Hospital, Metro South Health, QLD, Australia
Interests: cirrhosis; medication management; patient education; medication safety

Special Issue Information

Dear Colleagues,

The burden of chronic liver disease is rising, and clinicians face the challenge of safely managing medicines in this increasingly multimorbid patient group. Globally, the most prevalent chronic liver diseases are alcohol-associated liver disorder, nonalcoholic fatty liver disease, and viral hepatitis B and C. While treatment differs in the early stages, these chronic liver diseases all share a similar hepatitis-fibrosis sequence to cirrhosis.

Medication safety in liver disease is complex. Although medication errors can occur at any stage, people with advanced hepatic fibrosis and portal hypertension may be at greatest risk harm. Alterations in the pharmacology of medicines commonly occur in people with cirrhosis. Increased exposure to specific medications and the presence of complications (e.g., ascites, hepatic encephalopathy) can increase susceptibility to adverse effects. Patient behaviours (e.g. nonadherence) and health system factors (e.g. prescriber knowledge and support) may further complicate medication safety by reducing efficacy and impacting accessibility to pharmacotherapy and appropriate monitoring.

Tailored pharmacotherapy is needed to ensure safe and appropriate use of medicines in patients with liver disease. Pharmaceuticals invites all clinicians and researchers to share original contributions, reviews, and best practices that contribute to knowledge about medication safety in chronic liver disease. Topics may include pharmacological reviews, epidemiological studies, case reports of toxicological effects in patients with liver disease, and investigation of clinical interventions such as medication reviews to improve medication safety.

The collection of publications will be published as a Special Issue of the journal.

Dr. Sander D. Borgsteede
Dr. Kelly L. Hayward
Guest Editors

Manuscript Submission Information

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Keywords

  • Liver disease
  • Medication safety
  • Pharmacodynamics
  • Pharmacokinetics
  • Dosing
  • Systematic review
  • Case reports
  • Epidemiology
  • Implementation research
  • Adverse drug reactions
  • Clinical decision support
  • Gastro-enterology
  • Hepatology
  • Clinical pharmacology

Published Papers (2 papers)

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Research

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15 pages, 904 KiB  
Article
Medication Discrepancies and Regimen Complexity in Decompensated Cirrhosis: Implications for Medication Safety
by Kelly L. Hayward, Patricia C. Valery, Preya J. Patel, Catherine Li, Leigh U. Horsfall, Penny L. Wright, Caroline J. Tallis, Katherine A. Stuart, Michael David, Katharine M. Irvine, Neil Cottrell, Jennifer H. Martin and Elizabeth E. Powell
Pharmaceuticals 2021, 14(12), 1207; https://0-doi-org.brum.beds.ac.uk/10.3390/ph14121207 - 23 Nov 2021
Cited by 2 | Viewed by 1768
Abstract
Discrepancies between the medicines consumed by patients and those documented in the medical record can affect medication safety. We aimed to characterize medication discrepancies and medication regimen complexity over time in a cohort of outpatients with decompensated cirrhosis, and evaluate the impact of [...] Read more.
Discrepancies between the medicines consumed by patients and those documented in the medical record can affect medication safety. We aimed to characterize medication discrepancies and medication regimen complexity over time in a cohort of outpatients with decompensated cirrhosis, and evaluate the impact of pharmacist-led intervention on discrepancies and patient outcomes. In a randomized-controlled trial (n = 57 intervention and n = 57 usual care participants), medication reconciliation and patient-oriented education delivered over a six-month period was associated with a 45% reduction in the incidence rate of ‘high’ risk discrepancies (IRR = 0.55, 95%CI = 0.31–0.96) compared to usual care. For each additional ‘high’ risk discrepancy at baseline, the odds of having ≥ 1 unplanned medication-related admission during a 12-month follow-up period increased by 25% (adj-OR = 1.25, 95%CI = 0.97–1.63) independently of the Child–Pugh score and a history of variceal bleeding. Among participants with complete follow-up, intervention patients were 3-fold less likely to have an unplanned medication-related admission (adj-OR = 0.27, 95%CI = 0.07–0.97) compared to usual care. There was no association between medication discrepancies and mortality. Medication regimen complexity, frequent changes to the regimen and hepatic encephalopathy were associated with discrepancies. Medication reconciliation may improve medication safety by facilitating communication between patients and clinicians about ‘current’ therapies and identifying potentially inappropriate medicines that may lead to harm. Full article
(This article belongs to the Special Issue Medication Safety in Patients with Liver Disease)
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Review

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25 pages, 4173 KiB  
Review
Insights into an Immunotherapeutic Approach to Combat Multidrug Resistance in Hepatocellular Carcinoma
by Aswathy R. Devan, Ayana R. Kumar, Bhagyalakshmi Nair, Nikhil Ponnoor Anto, Amitha Muraleedharan, Bijo Mathew, Hoon Kim and Lekshmi R. Nath
Pharmaceuticals 2021, 14(7), 656; https://0-doi-org.brum.beds.ac.uk/10.3390/ph14070656 - 09 Jul 2021
Cited by 12 | Viewed by 3113
Abstract
Hepatocellular carcinoma (HCC) has emerged as one of the most lethal cancers worldwide because of its high refractoriness and multi-drug resistance to existing chemotherapies, which leads to poor patient survival. Novel pharmacological strategies to tackle HCC are based on oral multi-kinase inhibitors like [...] Read more.
Hepatocellular carcinoma (HCC) has emerged as one of the most lethal cancers worldwide because of its high refractoriness and multi-drug resistance to existing chemotherapies, which leads to poor patient survival. Novel pharmacological strategies to tackle HCC are based on oral multi-kinase inhibitors like sorafenib; however, the clinical use of the drug is restricted due to the limited survival rate and significant side effects, suggesting the existence of a primary or/and acquired drug-resistance mechanism. Because of this hurdle, HCC patients are forced through incomplete therapy. Although multiple approaches have been employed in parallel to overcome multidrug resistance (MDR), the results are varying with insignificant outcomes. In the past decade, cancer immunotherapy has emerged as a breakthrough approach and has played a critical role in HCC treatment. The liver is the main immune organ of the lymphatic system. Researchers utilize immunotherapy because immune evasion is considered a major reason for rapid HCC progression. Moreover, the immune response can be augmented and sustained, thus preventing cancer relapse over the post-treatment period. In this review, we provide detailed insights into the immunotherapeutic approaches to combat MDR by focusing on HCC, together with challenges in clinical translation. Full article
(This article belongs to the Special Issue Medication Safety in Patients with Liver Disease)
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