Cardiac diseases can often result in reduced metabolic activity in general because of poor hepatic and renal perfusion.7 Hepatic dysfunction can affect drug metabolism and biliary excretion.7 Renal insufficiency can be expected to impair renal drug metabolism and clearance.7 Uncontrolled hypothyroidism decreases the rate of drug metabolism and increases sensitivity to CNS depressants; and uncontrolled hyperthyroidism can increase the rate of drug metabolism and increases sensitivity to CNS stimulants.7
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