In conclusion, prescribing medicines in patients with liver disease is indeed challenging as almost 50% of the drugs in the physicians’ desk reference are known to cause liver injury. More than 100 drugs are incriminated in causing fulminant hepatic failure; only a few common ones have been mentioned in table 3 in this chapter. Furthermore, there are no clear tests which can identify altered drug metabolism in these patients. Thus, medications should be individualized depending upon the need, nutritional status, alternatives available and severity of liver disease. While giving a potentially hepatotoxic drug to a liver disease patient it is most important to monitor closely the clinical and biochemical parameters and to warn the patient and the family of the potential toxicity. Often clinicians have to choose between a devil and deep sea. Clinical judgement is paramount, but it should be backed by a sound knowledge of pharmacology and drug interactions.