Publication:

Drug utilization pattern, drug-related problems and associated risk factors in patients with hepatic impairment: a prospective observational study at a tertiary care teaching hospital

Background Because the liver drives the clearance of most medicines, any decline in hepatic function reshapes drug handling and leaves patients open to drug-related problems (DRPs). We set out to map the drug utilization pattern, characterise the DRPs, and identify the risk factors linked to hepatic impairment in admitted patients.

Methods A sample of 60 inpatients with hepatic impairment was studied prospectively over six months (February to August 2025) in the medicine ward of a tertiary care teaching hospital. Demographic, clinical, and prescription details were captured on structured forms. Severity was graded by the Child-Pugh score, prescribing quality was benchmarked against WHO core indicators, and DRPs were categorised by the Cipolle-Strand-Morley framework. Categorical associations were tested by chi-square, with the exact test for sparse cells; significance was set at p<0.05.

Results Most patients were men (95.0%); the 41-60-year band was largest (45.0%) and moderate disease (Child-Pugh B) prevailed (76.7%). Altogether 714 drugs were prescribed (mean 11.9 per patient); antibiotics (19.2%) and proton-pump inhibitors (13.2%) led non-hepatospecific classes, and ursodeoxycholic acid (16.1%) the hepatospecific agents. Generic prescribing reached only 25.6%, while 74.9% featured on the WHO Essential Medicines List. Fifty DRPs occurred in 42 patients (70.0%), chiefly drug-drug interactions (40.0%) and adverse drug reactions (20.0%). Comorbidity was significantly associated with DRPs (exact test, p=0.024), and alcohol overconsumption was the leading risk factor (88.3%).

Conclusions Prescribing leaned on antibiotics, acid suppressants, and hepatospecific agents, yet weak generic prescribing and a heavy comorbidity-driven DRP load mark clear openings for pharmacist-led optimisation and structured alcohol-abstinence counselling.