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J Palliat Med. 2007 Jun;10(3):677-85.

Palliation and liver failure: palliative medications dosage guidelines.

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Department of Palliative Care, Hope Healthcare, Braeside Hospital, Sydney, New South Wales, Australia.


Palliation of symptoms is important in a variety of conditions, both malignant and nonmalignant. These symptoms may be present in patients with chronic or acute liver failure. However, to date there is a notable lack of reliable information on the use of medications that are commonly required in the palliative care of these patients. To facilitate care, a literature review was conducted with extensive searches of MEDLINE and Micromedex as well as reviews of the major textbooks of pharmacology, palliative care, gastroenterology and hepatology. A table is presented that includes medications organized in groupings of functional importance in palliative medicine such as opioids, antiarrhythmics, antidepressants, aperients, and other medications as selected for use at a Sydney palliative care unit. Data have been collected on the pharmacologic half-life in normal liver function and in cirrhosis. The latter, where suitable data could be obtained, were divided into three subgroups, using the Child-Pugh criteria. The further development of this information may help limit difficulties in choice of medication and reduce potential complications and improve palliation.

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