In patients with cirrhosis, healthy liver tissue is damaged and the liver function deteriorates. The liver is important for breaking down medicines. Hence, patients with cirrhosis suffer more often from side effects because medicines accumulate. This can harm patients seriously. However, not all medicines are broken down by the liver, and currently it is not known which medicines can be used safely. The aim of my thesis was to improve safe medicine use in patients with cirrhosis. In the first part, we developed recommendations for healthcare professionals based on a systematic evaluation of clinical studies. We showed that out of over 200 medicines, 67 need a dose adjustment and 68 medicines should be avoided in patients with cirrhosis due to high risks of side effects. The recommendations can be found on: www.geneesmiddelenbijlevercirrose.nl and they are integrated in electronic prescribing systems used by physicians and pharmacists in the Netherlands. In the second part, we studied the current practice of medicine use in patients with cirrhosis. We found that 60% of 5,618 patients with cirrhosis used medicines which should be avoided. Often these were pain medicines. Although pharmacists were willing to improve medicine use, this was difficult as they often did not know which patients had cirrhosis. In the third part, we found that the information provided by the industry whether or not medicines can be used in cirrhosis is often unclear. To conclude, patients with cirrhosis need tailored pharmacotherapy. The recommendations we developed can support both patients and healthcare professionals.
|Qualification||Doctor of Philosophy|
|Place of Publication||[Groningen]|
|Publication status||Published - 2019|