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Dosage adjustments or closer monitoring may be necessary to ensure safe and effective use of the medication in this population

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For drugs that are highly extracted by the liver, bypassing hepatic sites of elimination (eg, in hepatic cirrhosis with portosystemic shunting) will result in substantial increases in drug availability, whereas for drugs that are poorly extracted by the liver (for which the difference between entering and exiting drug concentration is small), shunting of blood past the liver will cause little change in availability