Over-the-counter analgesics in cirrhotic patients: a case-control study examining the risk of hospitalization for liver-associated events

Abstract

Our data suggest that non-excessive OTCA use is not significantly associated with hospitalization for liver-associated events.

The Role of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in the Treatment of Patients With Hepatic Disease: A Review Article

“…However, the use of these drugs is uncontrolled and this, coupled with the fact that relatively few studies have been conducted in this area, has led NSAIDs being prescribed for even a simple headache (7, 11). Meanwhile, some studies has shown that liver damage due to the administration of vitamin A is more significant than that due to paracetamol or ibuprofen (11-13). Further, a study regarding the relationship between naproxen, diclofenac, and ibuprofen and gastrointestinal bleeding showed that the possibility of gastrointestinal bleeding is very insignificant for those aged less than 45 years (in both sexes) (14).…”

Acute Effects of Dipyrone on Renal Function in Patients with Cirrhosis: A Randomized Controlled Trial

“…Recently, a case-control study has shown that acetaminophen was the most common analgesic used by patients with cirrhosis, and this use at therapeutic doses was not associated with an increased risk of being hospitalized for liver-associated events [9]. Dipyrone is among the most used non-prescribed analgesic and antipyretic drugs in countries like Brazil, Israel, Mexico, Russia and Spain [10,11], while it has been banned in some countries because to its capacity to induce agranulocytosis and aplastic anaemia [12], an adverse effect that has been related to genetic factors and is more frequent in specific populations [13,14].…”

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

“…Regarding information given to patients about using OTCAs, only about half of the patients included in the survey by Fenkel et al ever reported having received medical advice on OTCA use by pharmacists or physicians [19]. The reluctance of trainees responding to our survey to use APAP at any dose in decompensated cirrhosis implies that further evidenced-based recommendations are needed for this patient population.…”

“…Although these recommendations were for the general population at large, with no specific guidelines offered for patients with CLD, there is evidence to suggest that APAP taken at therapeutic doses may be safe in patients with CLD. Fenkel et al demonstrated that "non-excessive" doses of OTCAs (NSAIDs and/or APAP) in patients with cirrhosis were not associated with an increased rate of hospitalization for liver related events [19]. The non-excessive dosage referred to in the study were listed as being less than the maximally recommended dose in the package label, although actual dosages in the study were not reported.…”

“…Among those with advanced cirrhosis who were hospitalized for a number of common causes of hepatic decompensation, a lower percentage (35%) mentioned taking over the counter analgesics with 19% saying they used acetaminophen and 16% took NSAIDs [14]. Of importance was the fact that hospitalization rates were not increased among cirrhotics using these over the counter analgesics, as reported by Fenkel et al [19].…”