The Impact of Liver Disease on Drug Metabolism

  • Jessica E. Bollinger


Any drug that is introduced to the body must be eliminated by either metabolism or excretion. The liver is the primary site of drug metabolism. Hepatic drug clearance depends upon liver blood flow, metabolic activity, and degree of protein binding. Cirrhosis may alter any or all of these variables. Caution must be exercised to interpret the impact of cirrhosis on drug metabolism.


Drug metabolism Cirrhosis Pharmacokinetics Adverse drug reactions Cytochrome Therapeutic drug monitoring 



Angiotensin converting enzyme


Area under the concentration-time curve


Hepatic clearance


Intrinsic clearance


Total plasma clearance


Maximum serum concentration


Cytochrome P450


Hepatic extraction ratio


Food and Drug Administration


Fraction of unbound drug in blood


Glomerular filtration rate




N-acetyl-p-benzoquinone imine


Hepatic blood flow


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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of PharmacyCleveland ClinicClevelandUSA

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