Table 4.

Summary of recommendations for opioid use in patients with liver disease

Name of drug	Half life in normal patients	Half life in patient with liver disease	Recommended dosing	Special consideration
Tramadol	5–6hrs	13–14hrs	50mg BD	Avoid in epileptic patients Risk of serotonin syndrome and/or toxicity with SSRI /TCA co adminsteration
Oxycodone	4–5 hrs	14hrs	5mg max QDS	Variable onset and efficacy
Morphine	3–4hrs	5hrs	5mg max QDS	Avoid with coexisting renal failure Prefer to Use elixir form
Methadone	19hrs	35Days	Not recommended, except as part of deaddiction programe	Seek expert help in dosing