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Loperamide hepatic impairment caution — GPhC CRA MCQ

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HardRenal and Hepatic ImpairmentLoperamide hepatic impairment cautionGPhC CRA

A patient with decompensated cirrhosis takes lactulose to prevent recurrent hepatic encephalopathy. Their carer reports new drowsiness, disorientation, abdominal swelling and several loose stools, and asks whether to stop lactulose and give loperamide. What is the best advice?

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Correct answer: A — Arrange emergency assessment; do not stop lactulose or add loperamide without review

New drowsiness and disorientation in decompensated cirrhosis may represent hepatic encephalopathy, infection, bleeding, electrolyte disturbance or other acute decompensation and needs emergency assessment. Lactulose is used to reduce toxin absorption and should not be stopped reflexively, while loperamide or codeine can worsen constipation and obscure assessment. Home fluid/protein restriction and delayed review are unsafe in an acutely altered patient.

Reference: NHS: cirrhosis. https://www.nhs.uk/conditions/cirrhosis/