Paracetamol is safe in patients with chronic liver disease but a reduced dose of 2-3 g/d is recommended for long-term use. Non-steroidal anti-inflammatory drugs (NSAIDs) are best avoided because of risk of renal impairment, hepatorenal syndrome, and gastrointestinal hemorrhage.
It is considered a first line analgesic for many patients with chronic liver disease (CLD), primarily due to concern about the side effects of non-steroidal anti-inflammatory (NSAID) and opioid- derived agents [2, 3].
Chronic liver disease patients are also at increased risk for hepatotoxicity, as paracetamol metabolism is decreased in patients with cirrhotic livers.
Acetaminophen (paracetamol), when taken in reduced doses (maximum 2–3 grams per day), is generally considered to be the safest pain relief option for your liver.
NSAIDs and aspirin should be avoided in patients with advanced CLD or cirrhosis. Low-dose acetaminophen should be used instead of NSAIDs.
Paracetamol overdose is one of the leading causes of acute liver failure. Adults can usually take one or two 500mg tablets every 4-6 hours, but shouldn't take more than 4g (eight 500mg tablets) in the space of 24 hours.
NSAIDs should be avoided in those with both compensated and decompensated cirrhosis, primarily because of the risk of acute renal failure due to prostaglandin inhibition. Opiates should be avoided or used sparingly at low and infrequent doses because of the risk of precipitating hepatic encephalopathy.
People with cirrhosis of the liver have a life expectancy of between two and 12 years. If you have early-stage cirrhosis, treatment and lifestyle changes can help you live longer. People with advanced cirrhosis of the liver have a much shorter life expectancy.
Ibuprofen has the highest liver safety profile among NSAIDs and showed no severe liver injury in larger studies. Along with paracetamol and aspirin, it is considered one of the most common over the counter NSAIDs sold in the world. Coxibs have currently replaced several NSAIDs due to safer GI profile.
Most people with liver disease report abdominal pain. Pain in your liver itself can feel like a dull throbbing pain or a stabbing sensation in your right upper abdomen just under your ribs.
Many people confuse acetaminophen (Tylenol) and ibuprofen. This is because they can treat many of the same symptoms. But there are key differences, especially when it comes to how they affect the liver and kidneys. Acetaminophen is harder on the liver than ibuprofen.
Nonprescription pain relievers such as acetaminophen (Tylenol, others), aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve, others) can damage your liver, especially if taken frequently or combined with alcohol.
Paracetamol can be taken on an empty stomach, while it is best to take ibuprofen with food, or soon after. Abuse of paracetamol can cause damage on your liver, while abuse of ibuprofen can cause damage to your stomach or liver. It's safer to take paracetamol if you are pregnant than ibuprofen.
Consider reducing the dose of paracetamol to a maxiumum of 3 g in 24 hours (for example 1 g three times daily) or use 15mg/kg every 4–6 hours (maximum of 60 mg/kg in 24 hours) as a guide. Monitor liver function tests if increased. Advise the person that they have been prescribed a lower dose and explain the reason why.
Other medications that should be avoided include abacavir, COX-2 inhibitors, nonsteroidal anti-inflammatory drugs, direct oral anticoagulant agents, sertraline, and tacrolimus. Herbal supplements have been shown to induce liver injury.
For people with liver disorders, ibuprofen use has adverse effects. The medication could worsen liver disease since it impairs the liver's ability to detoxify toxic compounds from the bloodstream.
For instance, nonsteroidal, anti-inflammatory drugs such as ibuprofen and naproxen, they should be avoided in patients with cirrhosis, because when the liver is scarred, there's a greater chance of hurting the kidneys with these types of medications.
The main treatments are cutting out salt from your diet and taking a type of medicine called a diuretic, such as spironolactone or furosemide.
Myth: I might have cirrhosis, but the liver will regenerate and heal itself naturally. Fact: The liver is a highly regenerative organ but only if it's still healthy enough to do so and doesn't have extensive scar tissue. Once cirrhosis is present, your liver's regeneration becomes very limited.
Compensated cirrhosis: People with compensated cirrhosis do not show symptoms, while life expectancy is around 9–12 years. A person can remain asymptomatic for years, although 5–7% of those with the condition will develop symptoms every year.
People with cirrhosis in Class A have the best prognosis, with a life expectancy of 15 to 20 years. People with cirrhosis in Class B are still healthy, with a life expectancy of 6 to 10 years. As a result, these people have plenty of time to seek sophisticated therapy alternatives such as a liver transplant.
Neuropathic Agents
The anticonvulsant medications, such as gabapentin and pregabalin (Lyrica) are not hepatically metabolized and frequently used to treat neuropathic pain.
Poorly absorbable oral antibiotics, statins, and albumin have been proposed as potential disease-modifying agents for cirrhosis (DMAC), since clinical studies have shown their capacity to prolong survival.
The main treatment for primary biliary cirrhosis is to slow liver damage with the drug ursodiol (Actigall, Urso). Ursodiol can cause side effects like diarrhea, constipation, dizziness, and back pain. Know more about the treatment options for primary biliary cirrhosis.