Monitoramento farmacoterapêutico em paciente com cirrose alcoólica: análise de hepatotoxicidade e intervenções potenciais

Abstract

ABSTRACT

Introduction: Patients with advanced cirrhosis face a high risk of liver deterioration due to polypharmacy, especially when exposed to hepatotoxic medications. Objectives: To evaluate the association between pharmacotherapy and the progression of liver dysfunction in a patient with mild Child-Pugh B cirrhosis, identifying high-risk medications and proposing interventions. Methods: Case report of a 52-year-old man with chemical cirrhosis (Child-Pugh B8, MELD 23), hospitalized for 35 days in a tertiary hospital. The prescribed medications were screened for hepatotoxicity risk according to the LiverTox database. Clinical and laboratory liver parameters were assessed throughout the hospitalization. Results: The patient used 23 medications, 10 of which were classified as high hepatotoxic risk (categories A and B). A temporal correlation was observed between the use of atorvastatin and enalapril and increased transaminases, bilirubin and alkaline phosphatase. Maintenance of atorvastatin and enalapril, despite signs of toxicity, represented an opportunity for clinical intervention. The patient's liver and kidney condition worsened, requiring hemodialysis and admission to the ICU, and he died from cardiorespiratory arrest. Conclusion: Pharmacotherapeutic monitoring highlighted the need for rigorous review of the prescription, especially regarding the early discontinuation of non-essential medications with a high hepatotoxic risk.