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

Prajwal S. Hallur; Aftabhusain Dhalayat; Vivek Kumar; Raghavendra S. Hegde

doi:10.18203/2320-6012.ijrms20263538

Authors

Prajwal S. Hallur Department of Pharmacy Practice, BVV Sangha’s Hanagal Shri Kumareshwar College of Pharmacy, Bagalkot, Karnataka, India
Aftabhusain Dhalayat Department of Pharmacy Practice, BVV Sangha’s Hanagal Shri Kumareshwar College of Pharmacy, Bagalkot, Karnataka, India
Vivek Kumar Department of Pharmacy Practice, BVV Sangha’s Hanagal Shri Kumareshwar College of Pharmacy, Bagalkot, Karnataka, India
Raghavendra S. Hegde Department of Pharmacy Practice, BVV Sangha’s Hanagal Shri Kumareshwar College of Pharmacy, Bagalkot, Karnataka, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20263538

Keywords:

Adverse drug reactions, Child-Pugh score, Drug-related problems, Drug utilization, Hepatic impairment, Rational prescribing

Abstract

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.

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