Use of Over-the-Counter Analgesics in Patients with Chronic Liver Disease

Rossi, Simona; Assis, David N.; Awsare, Monica; Brunner, Mark I.; Skole, Kevin; Rai, Jitha; Andrel, Jocelyn; Herrine, Steven K.; Reddy, Rajender; Navarro, Victor J.

doi:10.2165/00002018-200831030-00007

Cited by 56 publications

(66 citation statements)

References 27 publications

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“…Health care professionals frequently recommend avoidance of the use of acetaminophen in patients with liver disease or cirrhosis, whereas nSAIds are more commonly endorsed. 9 Variability and misconception regarding the safety of OTCAs for patients with hepatic dysfunction are widespread among health care professionals.…”

Section: Otca Medicationsmentioning

confidence: 99%

“…[9][10][11] Moreover, concern is increasing regarding the safety of acetaminophen at a maximal dosage of 4 g/d in the general population. Surveillance data from the United States from 1990 to 1998 estimated 56,000 emergency department visits, 26,000 hospitalizations, and 458 deaths per annum because of acetaminophen overdoses.…”

Section: Acetaminophenmentioning

confidence: 99%

“…29 nSAIdinduced (and idiosyncratic) hepatotoxicity has also been well described. 9 However, in cirrhotic patients with portal hypertension, the greater concern with nSAId use is the associated renal impairment, in particular hepatorenal syndrome. This is thought to be due to the inhibition of prostaglandins, which leads to a profound decrease in renal perfusion, reduction in GFR, and marked sodium retention.…”

Section: Acetaminophenmentioning

confidence: 99%

See 2 more Smart Citations

Pain Management in the Cirrhotic Patient: The Clinical Challenge

Chandok

Watt

2010

Mayo Clinic Proceedings

245

237

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Section: Otca Medicationsmentioning

confidence: 99%

Section: Acetaminophenmentioning

confidence: 99%

Section: Acetaminophenmentioning

confidence: 99%

See 1 more Smart Citation

Pain Management in the Cirrhotic Patient: The Clinical Challenge

Chandok

Watt

2010

Mayo Clinic Proceedings

245

237

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“…In 2008, Rossi et al studied physicians' attitudes regarding the use of over-the-counter nonprescription analgesics in CLD [10]. The results of their web-based questionnaire survey found that internists and family physicians were significantly more likely not to recommend the use of acetaminophen in patients with compensated cirrhosis compared to gastroenterologists, who felt that APAP would, in fact, be safe.…”

Section: Introduction Objectivementioning

confidence: 99%

Trainees’ Attitudes and Preferences towards the Use of Over the Counter Analgesics in Patients with Chronic Liver Disease

D¹

2014

Adv Pharmacoepidemiol Drug Saf

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“…A survey in four US healthcare areas among internists, general practitioners and specialists revealed a lower trend towards discouraging the use of NSAIDs versus paracetamol in patients with both compensated and decompensated cirrhosis; however, while non-specialists were less apt to recommend paracetamol versus NSAIDs for these patients, specialists had the opposite behavior. Anyway, the caution usually displayed by respondents suggests that pain management in cirrhosis might be insufficiently approached (5). On the other hand, a survey carried out in Spain a few years ago to review the way gastroenterology/hepatology specialists use drugs in inpatients with liver cirrhosis similarly showed a conservative attitude with a tendency to prescribe an average < 1 of the daily dose defined for drugs most commonly indicated for conditions associated with liver disease (including paracetamol, glibenclamide, lorazepam, captopril, and tiapride), with clomethiazole and amoxicillin-clavulanic -the use of which is controversial in the setting of cirrhosis-at the top of the list (6).…”

mentioning

confidence: 99%

Drugs prescription in patients with chronic liver disease: rules for adjusting doses and beyond

Andrade

Lucena

2012

Rev. esp. enferm. dig.

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The liver is the primary organ where biotransformation processes for drugs and other xenobiotics, necessary to turn originally fat-soluble compounds into more polar substances to facilitate urinary clearance, take place. Therefore, liver disease commonly brings about changes in the metabolism of multiple drugs. In addition to pharmacokinetic changes, chronic liver disease (particularly decompensated liver cirrhosis) induces changes (that is, an abnormal response) in the pharmacodynamics of various drugs and increases the severity of potential adverse events.While the spectrum of liver disease is wide, and hepatic functioning is preserved in many liver conditions, liver disorders are usually associated with physiological and/or structural changes that decrease the liver's metabolic capacity. Firstly, the absorption of a number of drugs may be disrupted by intestinal permeability changes that are characteristic of portal hypertension as well as by altered gastric voiding and bowel motility. Also, necrosis and liver cell dysfunction reduce the levels of liver enzymes responsible for drug metabolism, which affects plasma levels of active principles and hence their effectiveness and potential toxicity. On the other hand, altered liver structure and both intra-and extra-hepatic portosystemic shunts impair presystemic drug clearance for compounds with a high hepatic extraction ratio. Similarly, the synthesis of plasma transport proteins, basically albumin and alfa-glycoprotein, may be reduced, which affects the bioavailability of drugs highly bound to plasma proteins; drug excretion may become disrupted by variable cholestasis and, on occasion, renal impairment. Finally, advanced liver cirrhosis develops with an abnormal (usually exaggerated, deleterious) response to a number of drugs, including benzodiazepines, opiates, and non-steroidal antiinflammatory drugs (1). No wonder then that no single biochemical parameter (albumin, prothrombin activity) or cluster thereof is predictive of drug metabolism. Only general recommendations are issued that rely on a classification of drugs according to their flow-dependent, first-pass extraction ratio, their liver metabolism extent, and -within the latter group-their plasma protein binding degree (2); however, such proposal is a theoretical approach that more often than not is neither based on kinetic studies nor validated in prospective trials. In the present issue of The Spanish Journal of Gastroenterology, Periáñez et al. (3) make an attempt at issuing recommendations for the proper use of drugs in patients with chronic liver disease by using a strategy based on thoroughly reviewing prescribing information sheets, pharmaceutical databases, review articles, and the WHO list of drugs to be excluded or used cautiously in patients with liver disease, adding novel therapies, and adjusting said assessment to hospital medication guidelines. For cases where no relevant information could be found, adjustment recommendations followed the procedure defined by Delcò et al. (2). This strat...

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Use of Over-the-Counter Analgesics in Patients with Chronic Liver Disease

Cited by 56 publications

References 27 publications

Pain Management in the Cirrhotic Patient: The Clinical Challenge

Pain Management in the Cirrhotic Patient: The Clinical Challenge

Trainees’ Attitudes and Preferences towards the Use of Over the Counter Analgesics in Patients with Chronic Liver Disease

Drugs prescription in patients with chronic liver disease: rules for adjusting doses and beyond

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