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Drugs to be avoided or used with caution in liver disease

Active Ingredient Comments
ACE Inhibitors Use of prodrugs such as enala-pril, fosinopril, perindopril, quinapril and ramipril require close monitoring
Amlodipine Metabolised by liver: reduce dose
Antidepressants Tricylic Increased sedation: decrease dose. Avoid in severe disease
Antihistamines Avoid, may cause coma
Anxiolytics and hypnotics Decrease dose; may cause coma
Antipsychotics All may precipitate coma
Antidepressants SSRI Reduce dose or avoid in severe liver disease
Anticoagulants Avoid especially if PT is already prolonged
Aspirin Avoid - increased risk of gastro-intestinal bleeding
Astemizole see Antihistamines
Auranofin see Gold
Aurothiomalate see Gold
Azathioprine May need dose reduction
Azithromycin Avoid; jaundice reported
Bendrofluazide see Thiazides
Benzodiazepines see Anxiolytics and and hypnotics
Beta-blockers see individual drugs
Bumetanide see Loop Diuretics
Bupivacaine see Lignocaine
Carbamazepine Metabolism im-paired in ad-vanced liver disease