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I ran this by two hepatologists: one said there is no blood test to monitor how well the liver will metabolize a given medication- he said if there is a hx of encephalitis then don't try it- otherwise use caution and clinical judegemnt. the other said plt count and inr are the best measures of liver function (not lfts) - if those are wnl, ok to proceed- but both kind of indicated that it is a big unknown.
Maybe some one can provide guidelines based on lab results ... but I think there is still place for old fashioned clinical judgment where the doc uses his/her knowledge, experience, knows the patient and their various circumstances/factors. I think you did the right thing - you tried a low dose on each patient and followed up and made adjustments as needed. In one it didn't work so it was stopped. On the other it worked. Perhaps you might just follow that patient's liver tests but I'd hesitate to stop it if liver tests got a little worse (but patient clinically was not worse) - the benefit of Suboxone may be much greater than risk/harm.
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