What is the Child-Pugh score?

The Child-Pugh score is a five-parameter clinical scoring system that classifies the severity of chronic liver disease (cirrhosis). It scores bilirubin, albumin, prothrombin time prolongation, ascites, and hepatic encephalopathy on a 1–3 scale, giving a total of 5–15 points.

What do Child-Pugh Classes A, B, and C mean?

Class A (5–6 points) = mild impairment, Class B (7–9 points) = moderate impairment, Class C (10–15 points) = severe impairment. Many drug labels reference these classes to recommend dose reduction or avoidance.

Does this tool replace drug-specific prescribing information?

No. This is a general educational reference only. Always consult the official prescribing information (package insert) and a clinical pharmacist or physician before adjusting doses. Individual drug pharmacokinetics vary widely.

Why is hepatic dose adjustment important?

Many drugs are primarily metabolized in the liver (CYP450 enzymes, glucuronidation, etc.). Impaired liver function reduces first-pass metabolism and clearance, leading to higher plasma concentrations and increased toxicity risk if doses are not adjusted.

Can I use this for acute liver failure?

The Child-Pugh score was designed for chronic liver disease (cirrhosis). It is not validated for acute liver failure. Consult hepatology and pharmacology specialists for acute presentations.

Hepatic Dose Adjustment Guide

Name: Hepatic Dose Adjustment Guide
Availability: InStock
Author: Nham Vu

Enter five clinical parameters to calculate a Child-Pugh score, classify hepatic impairment severity, and review general dose adjustment guidance.

Child-Pugh Parameters

Select the value that best matches the patient's clinical status.

Total Bilirubin

Serum Albumin

PT Prolongation (seconds above normal)

Ascites

Hepatic Encephalopathy

Disclaimer: For educational reference only. Always verify against official prescribing information and consult a licensed clinician before adjusting doses.

Child-Pugh Score

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Select parameters and click Calculate

5 pts — Class A 10 pts — Class C 15 pts

General Dose Adjustment Guidance

Results will appear here after calculation.

Common Hepatically-Cleared Drugs

General patterns only — always check the full prescribing information.

Drug	Class A	Class B	Class C
Acetaminophen	Normal dose; limit duration	Reduce dose; max 2 g/day	Avoid if possible
Atorvastatin	Normal dose	Use with caution; monitor LFTs	Contraindicated
Metoprolol	Normal dose	Reduce; start at 25% of normal	Reduce; 12.5%–25% of normal
Warfarin	Normal; close INR monitoring	Reduce dose; frequent INR checks	Avoid or use very low doses with intensive monitoring
Morphine	Normal; monitor closely	Reduce 25–50%; longer intervals	Reduce 50%+; risk of encephalopathy
Diazepam	Normal; monitor sedation	Reduce dose significantly	Avoid; precipitates encephalopathy
Propranolol	Normal dose	Reduce by 50%; monitor	Reduce substantially; careful titration
Rifampicin	Use with caution	Reduce to 50% of normal dose	Avoid

Summary