Assess hepatic impairment severity and estimated maintenance adjustments. Review score inputs, warnings, and monitoring guidance. Use outputs carefully with prescribing references and patient labs.
Illustrative example only. Do not use sample values for patient care.
| Medication | Usual Dose | Interval | Bilirubin | Albumin | INR | Ascites | Encephalopathy | Hepatic Fraction | Estimated Output |
|---|---|---|---|---|---|---|---|---|---|
| Drug X | 100 mg | q24h | 2.6 mg/dL | 3.1 g/dL | 1.9 | Slight | None | 70% | ~58–65 mg q24h (depends on route/extraction) |
| Drug Y | 500 mg | q12h | 1.4 mg/dL | 3.7 g/dL | 1.2 | None | None | 20% | Often minor change; verify label |
| Drug Z | 50 mg | q24h | 4.2 mg/dL | 2.6 g/dL | 2.5 | Moderate | Grade 1–2 | 85% | Major reduction or extend interval; specialist review |
Step 1: Child-Pugh score = bilirubin points + albumin points + INR points + ascites points + encephalopathy points.
Step 2: Estimated remaining hepatic function uses class defaults (A 0.80, B 0.60, C 0.40) or your manual override.
Step 3: Clearance factor
CL_factor = (1 - fhepatic) + (fhepatic × H_factor)
Step 4: Oral bioavailability factor (optional)
For oral/enteral drugs, the tool applies a first-pass adjustment using the selected extraction ratio class.
Step 5: Maintenance dose factor
Dose_factor ≈ CL_factor / F_factor
Step 6: Strategy output
Reduce dose, extend interval, or split changes (hybrid) to target a similar maintenance exposure. This is a heuristic estimate, not labeling.
This calculator supports structured maintenance dose planning when liver impairment may change drug clearance or oral bioavailability. It combines Child-Pugh severity inputs with medicine-specific assumptions, then returns a transparent adjustment estimate. Teams can document dose, interval, route, and monitoring notes in one page. The design is useful during ward reviews, pharmacist verification, and discharge reconciliation, where repeatable calculations reduce variation and improve handoff quality. Trend reviews every 48 hours help keep recommendations aligned with changing liver status.
The scoring block uses bilirubin, albumin, INR, ascites, and encephalopathy to classify impairment as A, B, or C. Total scores of 5–6 indicate mild impairment, 7–9 indicate moderate impairment, and 10–15 indicate severe impairment. This classification does not prescribe a medicine dose by itself, but it anchors risk discussions and drives the calculator’s hepatic function factor defaults. Entering current values matters because rapid changes can alter the result meaningfully.
The estimate applies a clearance factor using hepatic metabolism fraction and hepatic function factor. If oral or enteral administration is selected, the tool can apply a bioavailability factor using extraction ratio assumptions. The maintenance factor is approximated as clearance divided by bioavailability. This method is conservative and transparent: every input remains visible so pharmacists and prescribers can challenge assumptions before acting.
After submission, results appear above the form for quick review during rounds. The output table summarizes Child-Pugh class, normalized bilirubin, estimated hepatic function, maintenance factor, suggested dose, suggested interval, and risk flag. Warning statements highlight narrow therapeutic index medicines, severe impairment, and high-extraction oral drugs. The CSV export supports chart documentation, while the PDF button helps teams attach a readable summary to internal review packets.
Use the calculator as a decision-support layer, not a replacement for labeling. Start with the official recommendation, then compare the calculator estimate to identify large differences needing discussion. Reassess inputs when albumin, INR, or bilirubin trends change. For unstable patients, document assumptions clearly and shorten follow-up monitoring intervals. Consistent inputs, visible formulas, and repeatable outputs improve auditability across shifts and care settings.
No. It is an educational support tool. Final dosing decisions should follow official product labeling, clinical pharmacist review, patient-specific factors, and monitoring results.
It is most useful for adults with chronic liver impairment where Child-Pugh scoring and maintenance dose planning are relevant. It is less suitable for acute overdose, fulminant hepatic failure, or rapidly changing critical illness.
Use the strategy that matches the drug’s pharmacodynamics, formulation, and monitoring plan. The tool shows both options, but product labeling and clinician judgment should guide which approach is safer.
For oral or enteral medicines, hepatic impairment can increase bioavailability by reducing first-pass metabolism. High-extraction drugs may show larger exposure increases, so the calculator applies an optional bioavailability factor.
Use reliable labeling or pharmacokinetic references whenever possible. If unknown, estimate cautiously, document the assumption in notes, and treat the output as a screening estimate requiring closer clinical review.
Repeat it when bilirubin, albumin, INR, mental status, ascites severity, route, or dose strategy changes. Recalculation is especially important during admission, therapy escalation, or worsening hepatic function.
Important Note: All the Calculators listed in this site are for educational purpose only and we do not guarentee the accuracy of results. Please do consult with other sources as well.