5PSQ-072 Drug prescription in hepatic cirrhosis: pitfalls and room for improvement

<h3>Background and Importance</h3> In our region, the prevalence of cirrhosis is 3 per 1,000 inhabitants. It is estimated that approximately 20% of prescriptions in patients with cirrhosis are inappropriate due to inadequate dosing or contraindication. This can lead to adverse drug reactions that are preventable. <h3>Aim and Objectives</h3> To evaluate the adequacy of medications in patients with cirrhosis according to their hepatic disease. <h3>Material and Methods</h3> Cross-sectional drug utilisation study. Patients with a diagnosis of hepatic cirrhosis in their electronic clinical record until June 2023 were included. Collected variables were: age, gender, Child-Pugh classification and prescribed medications between April and June 2023. Prescriptions of contraindicated drugs in cirrhosis such us analgesics, antidepressants, antidiabetics, antihistamines, antibiotics, antipsychotics, antithrombotics, benzodiazepines, cardiovascular and digestive therapies were reviewed. Safety information was checked in <i>Geneesmiddelen bij</i> database.¹ Due to the lack of Child-Pugh classification in most of the patients’ clinical records, only contraindicated drugs in all stages of cirrhosis were analysed. <h3>Results</h3> A total of 1326 patients (64.1% males) with mean age of 65±12 years were included. The severity of cirrhosis was unknown in 89.6% of patients, 52 patients were classified as Child-Pugh A (3.9%), 63 as Child-Pugh B (4.8%) and 23 as Child-Pugh C (1.7%). One quarter of patients (25.3%) had a prescription of a contraindicated drug. Most frequently involved medication groups were: proton pump inhibitors (pantoprazole, lansoprazole): 38.5%, lipid-lowering drugs (atorvastatin): 30.4%, nonsteroidal anti-inflammatory drugs (ibuprofen, dexketoprofen, naproxen, celecoxib, etoricoxib, diclofenac, aceclofenac, lornoxicam and chondroitin sulphate): 21.3% and hypnotics (zolpidem): 7.4%. <h3>Conclusion and Relevance</h3> Prescription in cirrhosis must improve. The prevalence of patients taking contraindicated drugs in cirrhosis in our study is slightly higher than in bibliography, in spite of there being safer options available for all of them. The lack of knowledge about drug management in cirrhosis and the need for information and training in this field are highlighted. It is important to grade cirrhosis according to the Child-Pugh classification, as drugs can be contraindicated depending on stage. We propose to implement a prescription-related alert system, which alerts about contraindicated drugs in cirrhosis and suggests safer alternatives. <h3>References and/or Acknowledgements</h3> Borgsteede <i>et al</i>. Geneesmiddelen bij levercirrose. Accessed 20 June 2023. https://www.geneesmiddelenbijlevercirrose.nl/ <h3>Conflict of Interest</h3> No conflict of interest