Interactions of Drugs for Liver Diseases

Liver diseases show increasing trends in incidence and prevalence worldwide. Chronic liver diseases (CLD) finally result in the development of cirrhosis and liver failure, leading to death or the need for liver transplantation. Therefore, it is important to early recognize patients under risk for such a scenario and treat them accordingly including both preventive lifestyle measures and introducing drug treatment when indicated. Interactions of drugs used to treat liver disease may be affected by pharmacokinetic and pharmacodynamic interactions at different levels, starting from the intestinal absorption, drug uptake, biotransformation and elimination by the hepatocytes, biliary and renal excretion. Some of these steps may be significantly affected by the altered liver function as CLD advances, but also by the inherited genetic variants of the genes involved in these processes. In this chapter, clinically most relevant interactions of drugs commonly used to treat liver diseases are discussed, from classical drugs such as diuretics and corticosteroids to the most recently introduced antivirals and bile acid analogues.