LAUSR

Background and Aims: Patients with liver cirrhosis are at risk to develop adverse events because of altered pharmacokinetics and pharmacodynamics. Some drugs have known safety risks in patients with cirrhosis, such as NSAIDs and benzodiazepines. There is not much known about drug use in these patients in ambulatory care, where drug use might be more risky because of less monitoring. Therefore,we aim to explore which drugs patients with liver cirrhosis use in ambulatory care. Method: In this retrospective longitudinal cohort study, data from an out-patient pharmacy database were combined with hospitalization data (PHARMO Database Network). Patients with a clinical diagnosis of cirrhosis (ICD-9 code 571.2 or 571.5) between January 1998 and December 2015were included in the study. The index datewas the first day of discharge from hospital with the diagnosis of cirrhosis. Data on drug dispensions were analyzed during the total follow-up of a patient. Results: In total 5,618 patients (59%males)were included with amean age at the index date of 60.7 ± 12.5 years. Patients were followed for a median of 3 years (interquartile range (IQR) 3) after the index date. In 179 patients (3.2%) follow-up ended because of a liver transplantation. During the total follow-up, 102,297 drugs were prescribed. General practitioners prescribed 61.5% of these drugs, specialists 36.4% and the prescriber was unknown in 2.2%. Patients used a median of 6.8 unique drugs per person per year (IQR 8.4). Drugs for acid related disorders (mainly proton pump inhibitors) were the most frequently used therapeutic group (70.9% of patients) followed by diuretics (63.5%) and antibacterials for systemic use (61.9%). For individual drugs, spironolactone (48.7%), furosemide (44.0%) and pantoprazole (34.9%) where used most often. Temazepam (23.2%), diclofenac (22.2%) and paracetamol (21.3%) were the most frequently used drugs for non-liver related co-morbidities. Looking at the group of benzodiazepines and NSAIDs; they were used by respectively 46.2% and 37.1% of patients during the total follow-up. Conclusion: Patientswith cirrhosis frequently use drugs in ambulatory care. A substantial proportion of patients used drugs with known safety risks in cirrhosis, such as NSAIDs and benzodiazepines. Attention is needed for both specialists and general practitioners when prescribing drugs to these fragile patients to prevent adverse events.