Question:
Which fluoroquinolone is contraindicated (dose must be reduced) in liver disease?
Which fluoroquinolone is contraindicated (dose must be reduced) in liver disease?
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Find the quinolone that is hepatically cleared and accumulates, unlike the renally excreted rest.
Updated On: Jun 23, 2026
- Levofloxacin
- Pefloxacin
- Ofloxacin
- Lomefloxacin
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The Correct Option is B
Solution and Explanation
Step 1: Most fluoroquinolones (levofloxacin, ofloxacin, lomefloxacin) are eliminated mainly by the kidney, so their dose is adjusted in renal impairment.
Step 2: Pefloxacin is the exception. It is largely metabolised in the liver and has a long half-life, so it accumulates on repeated dosing, reaching plasma levels about twice those after a single dose.
Step 3: Because of this hepatic handling, the dose of pefloxacin must be reduced in liver disease but not in renal insufficiency. This makes option B correct, while the renally cleared agents are the wrong choices.
Ref: K. D. Tripathi, Essentials of Medical Pharmacology, 7th edition, page 713.
Step 2: Pefloxacin is the exception. It is largely metabolised in the liver and has a long half-life, so it accumulates on repeated dosing, reaching plasma levels about twice those after a single dose.
Step 3: Because of this hepatic handling, the dose of pefloxacin must be reduced in liver disease but not in renal insufficiency. This makes option B correct, while the renally cleared agents are the wrong choices.
Ref: K. D. Tripathi, Essentials of Medical Pharmacology, 7th edition, page 713.
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