Dose adjustment of drugs with high hepatic extraction are required in patients with severe liver disease

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Severe liver disease may result in dose-related or idiopathic increases in drug exposure and adverse effects, especially with drugs with a high hepatic extraction and narrow therapeutic index. The dose of drugs may be adjusted according to their degree of hepatic extraction and protein binding. As patients with liver cirrhosis may also have impaired renal function, the dose of drugs with predominantly renal elimination may also have to be adapted

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