The Child-Pugh scoring system
aims to classify the severity of liver disease; it does not determine the
livers ability to clear medications.
The scoring system can be
seen in the table below:
Mild impairment: Child-Pugh A is a score of 5-6 indicating a well-compensated liver.
Moderate impairment: Child-Pugh B is a score of 7-9 indicating significant functional
Severe impairment: Child-Pugh C is a score of 10-15 indicating a decompensated liver.
The BNF and Summary of
Product Characteristics (SPC) will advise on dose reductions of some
medications based on either ‘mild, moderate or severe impairment’ or based on
the patients Child-Pugh score. If the SPC does not advise regarding dosing in
patients with hepatic impairment, it is important to consider both
patient-specific factors and drug-specific factors before reducing the dose of some
Firstly, consider the patient
and their diagnosis, the trend of the liver function tests and their signs/symptoms
of liver disease. Secondly, the pharmacokinetics of the drug should be reviewed
and how it will be impacted in hepatic impairment.
For example, if a patient’s
hepatic function is acutely deranged due to infection, and not thought to be
cirrhotic, then a dose reduction would be inappropriate. Be mindful of using
nephrotoxic medications in patients with decompensated liver disease due to the
risk of hepatorenal syndrome.
Please contact your
pharmacist for further advice.
The following antimicrobials need careful consideration in hepatic impairment: