How does cirrhosis affect drug metabolism?

Cirrhosis has a profound impact on the liver, which is the primary organ responsible for drug metabolism. In the context of cirrhosis, liver architecture is altered due to scar tissue buildup, leading to impaired blood flow and dysfunctional hepatocyte activity. This impairment reduces the liver's ability to metabolize drugs effectively. As a result, drugs that are typically processed by the liver may accumulate in the body, leading to increased levels in the bloodstream. This accumulation raises the risk of adverse effects and toxicity, particularly with medications that have a narrow therapeutic index.

The impairment in drug metabolism caused by cirrhosis can manifest through several mechanisms, including decreased enzyme activity, altered hepatic circulation, and diminished synthesis of proteins that bind drugs. Consequently, the altered pharmacokinetics in individuals with cirrhosis necessitates careful consideration and often dosage adjustments for medications to avoid toxicity and ensure efficacy. Thus, the correct understanding of the relationship between cirrhosis and drug metabolism is crucial for patient safety and effective treatment planning.