European Journal of Clinical Pharmacology

, Volume 68, Issue 2, pp 179–188 | Cite as

Potential drug-drug interactions and adverse drug reactions in patients with liver cirrhosis

  • Carmen C. Franz
  • Sabin Egger
  • Christa Born
  • Alexandra E. Rätz Bravo
  • Stephan KrähenbühlEmail author
Pharmacoepidemiology and Prescription


Background and aims

Patients with liver cirrhosis may be at risk for potential drug-drug interactions (pDDIs) and/or adverse drug reactions (ADRs) due to the severity of their disease and comorbidities associated with polypharmacy.


We performed a cross-sectional retrospective study including 400 cirrhotic patients and assessed diagnoses, medication patterns, pDDIs, and ADRs at hospital admission.


The median (range) age of the patients was 60 (21–88) years; 68.5% were male. They had a total of 2,415 diagnoses, resulting in 6 (1–10) diagnoses per patient. Frequent were diagnoses of the digestive system (28.4%), circulatory system (14.2%), blood and blood-forming organs (8.7%), and psychiatric disorders (7.5%); 60.7% of the diagnoses were not liver-associated. The median number of drugs per patient was 5 (0–18), whereof 3 (0–16) were predominantly hepatically eliminated. Drugs were primarily indicated for gastrointestinal, cardiovascular, or nervous system disorders, reflecting the prevalent diagnoses. In 112 (28%) patients, 200 ADRs were detected, mainly associated with spironolactone, torasemide, furosemide, and ibuprofen. In 86 (21.5%) patients, 132 pDDIs were detected. Seven of these pDDIs were the direct cause of 15 ADRs, whereof 3 resulted in hospital admission. Patients with ADRs were older, had more comorbidities, were treated with more drugs, and had a worse renal function and more pDDIs than patients without ADRs.


Pharmacotherapy is complex in cirrhotic patients. Hepatologists should know the principles of dose adjustment in cirrhosis and renal failure, but also the most important pDDIs of the drugs used to treat liver disease and comorbidities in this population.


Liver cirrhosis Drug-drug interactions Adverse drug reactions Dose adjustment 



Potential drug-drug interactions


Adverse drug reactions


Nonsteroidal anti-inflammatory drugs


Extrarenal elimination fraction

ATC code

Anatomical Therapeutic Chemical Classification System


Angiotensin-converting enzyme


Hematopoietic stem cell transplantation


Renin angiotensin aldosterone system


Selective serotonine reuptake inhibitor




Conflict of interest

None of the authors indicates a conflict of interest with this work.

Financial support

S.K. is supported by the Swiss National Science Foundation (31003A_132992/1).

Supplementary material

228_2011_1105_MOESM1_ESM.doc (48 kb)
ESM 1 (DOC 48.5 kb)


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Carmen C. Franz
    • 1
  • Sabin Egger
    • 1
  • Christa Born
    • 1
  • Alexandra E. Rätz Bravo
    • 1
    • 2
  • Stephan Krähenbühl
    • 1
    Email author
  1. 1.Division of Clinical Pharmacology and ToxicologyUniversity HospitalBaselSwitzerland
  2. 2.Regional Pharmacovigilance CenterUniversity HospitalBaselSwitzerland

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