Article (Scientific journals)
Pharmacokinetic and toxicological considerations for the treatment of diabetes in patients with liver disease.
Scheen, André
2014In Expert Opinion on Drug Metabolism and Toxicology
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Keywords :
chronic liver disease; type 2 diabetes mellitus; oral antidiabetic agent; cirrhosis; glucose-lowering therapy; hepatic impairment; hepatotoxicity; , pharmacokinetics
Abstract :
[en] Introduction: Patients with type 2 diabetes have an increased risk of chronic liver disease (CLD) such as non-alcoholic fatty liver disease and steatohepatitis and about one-third of cirrhotic patients have diabetes. However, the use of several antidiabetic agents may be a cause for concern in the case of hepatic impairment (HI). Areas covered: An extensive literature search was performed to analyze the influence of HI on the pharmacokinetics (PK) of glucose-lowering agents and the potential consequences for clinical practice as far as the efficacy/safety balance of their use in diabetic patients with CLD is concerned. Expert opinion: Almost no PK studies have been published regarding metformin, sulfonylureas, thiazolidinediones and alpha-glucosidase inhibitors in patients with HI. Only mild changes in PK of glinides, dipeptidyl peptidase-4 inhibitors and sodium glucose cotransporters type 2 inhibitors were observed in dedicated PK studies in patients with various degrees of HI, presumably without major clinical relevance although large clinical experience is lacking. Glucagon-like peptide-1 receptor agonists have a renal excretion rather than liver metabolism. Rare anecdotal case reports of hepatotoxicity have been described with various glucose-lowering agents contrasting with numerous reassuring data. Nevertheless, caution should be recommended, especially in patients with advanced cirrhosis, including with the use of metformin.
Disciplines :
Endocrinology, metabolism & nutrition
Pharmacy, pharmacology & toxicology
Gastroenterology & hepatology
Author, co-author :
Scheen, André  ;  Université de Liège - ULiège > Département des sciences cliniques > Diabétologie, nutrition et maladie métaboliques
Language :
English
Title :
Pharmacokinetic and toxicological considerations for the treatment of diabetes in patients with liver disease.
Publication date :
2014
Journal title :
Expert Opinion on Drug Metabolism and Toxicology
ISSN :
1742-5255
eISSN :
1744-7607
Publisher :
Informa Healthcare, United Kingdom
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 15 May 2014

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