As a rule, NSAIDs should be used cautiously in patients with cirrhosis ( 2).Īlthough analgesic are commonly used and can affect the natural course of disease in patients cirrhosis, there are few recommendations regarding the proper use of analgesics in this population ( 2, 3, 4). NSAIDs can also cause new-onset ascites in patients with compensated cirrhosis or makes it difficult to control existing ascites. NSAIDs can cause gastrointestinal bleeding, hepatic injury, and acute kidney injury more frequently in patients with cirrhosis. Many drugs increase the risk of hepatic injury and exacerbation of clinical sequelae in patients with cirrhosis.Īlthough acetaminophen is known as a hepatotoxic drug at higher dose, it can be used safely in maximum daily dose of 2 to 3 grams per day or up to 4 grams per day in the short term in most patients with cirrhosis, including those who regularly consume alcohol ( 1). Cirrhotic liver is vulnerable to cellular injury by many drugs. The prescription of the proper type of analgesics is important to relieve pain more effectively and avoid unnecessary adverse events.Īnalgesics including non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen, are some of the most frequently prescribed drugs in patients with cirrhosis. Various types of analgesics can be used in the treatment of pain. The management of pain in these patients, however, is a clinical challenge to physicians and a source of considerable misconception and concern among physicians. Pain relief is essential to improve quality of life for these patients. The harmful effects of NSAIDs in patients with cirrhosis should be reminded to all physicians prescribing analgesics.Īcute or chronic pain is one of the most common symptoms suffered by patients with cirrhosis secondary to various comorbidities. The prescription pattern of analgesics were different significantly among physicians in patients with liver cirrhosis. NSAIDs were more frequently prescribed although they should be avoided. Analgesics were prescribed in 40.5% of patients with cirrhosis. Gastroenterologists more frequently prescribed acetaminophen over NSAIDs compared to other internists (80.9% vs. Internists more frequently prescribed acetaminophen than NSAIDs compared to other physicians (50.9% vs. There was a marked difference in prescription preference between acetaminophen and NSAIDs among physicians. NSAIDs were more prescribed than acetaminophen even in decompensated cirrhosis compared with compensated cirrhosis (71.5% vs. Overall, NSAIDs (82.7%) were more prescribed than acetaminophen (64.5%). Of that group, 50,798 (40.5%) patients claimed reimbursement for at least one prescription for acetaminophen or NSAIDs during the one year follow-up period. A total of 125,505 patients with liver cirrhosis were registered from Januto December 31, 2012. We assessed the prescription pattern of acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) in patients with liver cirrhosis registered in Health Insurance Review Assessment Service database between Januand December 31, 2012. Therefore, we aimed to evaluate the prescription pattern of most frequently used analgesics in patients with cirrhosis. No guidelines are available regarding the prescription of analgesics in these patients. Analgesics, known to be hepatotoxic drugs, are frequently prescribed to patients with liver cirrhosis who are prone to drug-induced liver injury.