Reasons Given By Trainees for Avoiding the Use of Acetaminophen and Non-Steroid Anti-Inflammatory Drugs In Patients With Chronic Liver Disease

Nguyen, Dennis; Banerjee, Nikhil; Rivas, C.; Ibrahim, Dalia; Lewis, James H.

doi:10.14309/00000434-201210001-00389

Cited by 2 publications

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“…that compared primary care physicians to practising gastroenterologists . Reasons for their preferences given by the trainees, who were worried about using paracetamol, reflected their concerns about worsening underlying liver disease, producing an inadvertent overdose, and the overall lack of evidence‐based information on which to justify clinical decisions in this setting . Both surveys illustrate that a significant variability exists among health care providers regarding their recommendations for the use of OTCAs and affords another opportunity for physician as well as patient education on medication use in CLD.…”

Section: Resultsmentioning

confidence: 99%

Review article: prescribing medications in patients with cirrhosis – a practical guide

Lewis

Stine

2013

Aliment Pharmacol Ther

171

161

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Summary Background Most drugs have not been well studied in cirrhosis; recommendations on safe use are based largely on experience and/or expert opinion, with dosing recommendations often based on pharmacokinetic (PK) changes. Aim To provide a practical approach to prescribing medications for cirrhotic patients. Methods An indexed MEDLINE search was conducted using keywords cirrhosis, drug‐induced liver injury, pharmacodynamics (PDs), PKs, drug disposition and adverse drug reactions. Unpublished information from the Food and Drug Administration and industry was also reviewed. Results Most medications have not been adequately studied in cirrhosis, and specific prescribing information is often lacking. Lower doses are generally recommended based on PK changes, but data are limited in terms of correlating PD effects with the degree of liver impairment. Very few drugs have been documented to have their hepatotoxicity potential enhanced by cirrhosis; most of these involve antituberculosis or antiretroviral agents used for HIV or viral hepatitis. Paracetamol can be used safely when prescribed in relatively small doses (2–3 g or less/day) for short durations, and is recommended as first‐line treatment of pain. In contrast, NSAIDs should be used cautiously (or not at all) in advanced cirrhosis. Proton pump inhibitors have been linked to an increased risk of spontaneous bacterial peritonitis (SBP) in cirrhosis and should be used with care. Conclusions Most drugs can be used safely in cirrhosis, including those that are potentially hepatotoxic, but lower doses or reduced dosing frequency is often recommended, due to altered PKs. Drugs that can precipitate renal failure, gastrointestinal bleeding, SBP and encephalopathy should be identified and avoided.

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Section: Resultsmentioning

confidence: 99%

Review article: prescribing medications in patients with cirrhosis – a practical guide

Lewis

Stine

2013

Aliment Pharmacol Ther

171

161

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A Systematic Review of the Evidence Behind Use of Reduced Doses of Acetaminophen in Chronic Liver Disease

Schweighardt

Juba

2018

Journal of Pain & Palliative Care Pharmacotherapy

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Acetaminophen is among the most commonly used nonopioid analgesics, but significant variation exists in its prescribing practices for cirrhosis patients. Our primary objective was to describe the quality of evidence supporting or refuting the use of acetaminophen in patients with hepatic dysfunction. A comprehensive literature review of PubMed, Cochrane Library, Web of Science, and International Pharmaceutical Abstracts using the search terms "acetaminophen," "paracetamol," "chronic liver disease," "cirrhosis," and "hepatic disease" for studies describing changes in acetaminophen metabolism in patients with hepatic dysfunction was conducted. Twelve studies and four abstracts were included. Ten studies and three abstracts were pharmacokinetic studies. Two studies and one abstract evaluated the association of acetaminophen use and decompensation in the cirrhotic patient. The level of certainty for dosing recommendations obtainable from reviewing the evidence is low due to a small number of studies meeting search criteria, small samples sizes, inadequate information regarding cirrhosis etiology and compensated versus uncompensated liver disease, and lack of information on patient centered health outcomes. High-quality trials are not available to support the use of decreased acetaminophen doses in compensated cirrhosis patients. Acetaminophen can be a safe analgesic in patients with compensated hepatic dysfunction after careful analysis of patient-specific factors. Disciplines Disciplines Pharmacy and Pharmaceutical Sciences Comments Comments

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Reasons Given By Trainees for Avoiding the Use of Acetaminophen and Non-Steroid Anti-Inflammatory Drugs In Patients With Chronic Liver Disease

Cited by 2 publications

References 0 publications

Review article: prescribing medications in patients with cirrhosis – a practical guide

Review article: prescribing medications in patients with cirrhosis – a practical guide

A Systematic Review of the Evidence Behind Use of Reduced Doses of Acetaminophen in Chronic Liver Disease

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