Cefixime (Zifi 400) and Liver Effects
Cefixime does not require dose adjustment in patients with liver disease and has minimal hepatotoxic potential, making it safe for use even in patients with cirrhosis. 1, 2
Hepatotoxicity Profile
Cefixime is not significantly hepatotoxic and transient elevations in liver enzymes (SGPT, SGOT, alkaline phosphatase) occur in less than 2% of patients, with rare cases of hepatitis or jaundice reported. 1
The FDA label lists hepatic adverse effects as uncommon post-marketing findings rather than frequent clinical trial observations, indicating these are rare events. 1
Pharmacokinetics in Liver Disease
No dosage adjustment is needed in cirrhotic patients, even with severe hepatic impairment. 2, 3
In cirrhotic patients, cefixime's elimination half-life increases from 3-4 hours to approximately 6.5 hours due to increased volume of distribution from ascites and hypoalbuminemia, but this does not require dose modification. 2, 3
Maximum serum concentrations and area-under-the-curve values remain unchanged in patients with liver failure. 2
Cefixime is cleared 60% by the liver and 40% by the kidneys; in cirrhotic patients, renal clearance compensates by increasing, possibly due to reduced extra-renal clearance. 2, 3
Clinical Monitoring Considerations
Routine liver function monitoring is not required for cefixime use, unlike many other antimicrobials. 1
Patients with both renal and hepatic impairment may be at slightly higher risk for coagulation abnormalities; prothrombin time should be monitored in patients with combined renal/hepatic impairment or poor nutritional state. 1
Comparison to Other Antimicrobials
Cefixime's hepatic safety profile is notably better than many other antimicrobials, which commonly cause hepatotoxicity ranging from minor enzyme elevations to fulminant hepatic failure. 4
Unlike tuberculosis medications (pyrazinamide, ethionamide) which cause hepatotoxicity in 1-2% of patients and require increased monitoring in liver disease, cefixime does not necessitate such precautions. 5
Practical Recommendations
Cefixime can be used safely in patients with any degree of liver disease without dose adjustment. 2, 3
The drug can be taken with or without food, as food does not affect absorption. 3
If hepatic adverse effects occur (extremely rare), discontinue the medication and consider alternative antibiotics. 1