Paper Information

Journal:   HEPATITIS MONTHLY   OCTOBER 2014 , Volume 14 , Number 10; Page(s) 0 To 0.
 
Paper: 

THE THERAPEUTIC USE OF ANALGESICS IN PATIENTS WITH LIVER CIRRHOSIS: A LITERATURE REVIEW AND EVIDENCE-BASED RECOMMENDATIONS

 
 
Author(s):  IMANI FARNAD, MOTAVAF MAHSA, SAFARI SAEID, ALAVIAN SEYED MOAYED*
 
* DEPARTMENT OF MOLECULAR HEPATOLOGY, MIDDLE EAST LIVER DISEASE CENTER, TEHRAN, IR IRAN
 
Abstract: 

Context: Pain management in cirrhotic patients is a major clinical challenge for medical professionals. Unfortunately there are no concrete guidelines available regarding the administration of analgesics in patients with liver cirrhosis. In this review we aimed to summarize the available literature and suggest appropriate evidence-based recommendations regarding to administration of these drugs.
Evidence Acquisition: An indexed MEDLINE search was conducted in July 2014, using keywords "analgesics", "hepatic impairment", "cirrhosis", "acetaminophen or paracetamol", "NSAIDs or nonsteroidal anti-inflammatory drugs", "opioid" for the period of 2004 to 2014. All randomized clinical trials, case series, case report and meta-analysis studies with the above mentioned contents were included in review process. In addition, unpublished information from the Food and Drug Administration are included as well.
Results: 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. Most opioids can have deleterious effects in patients with cirrhosis. They have an increased risk of toxicity and hepatic encephalopathy. They should be administrated with lower and less frequent dosing in these patients and be avoided in patients with a history of encephalopathy or addiction to any substance.
Conclusions: No evidence-based guidelines exist on the use of analgesics in patients with liver disease and cirrhosis. As a result pain management in these patients generates considerable misconception among health care professionals, leading under-treatment of pain in this population. Providing concrete guidelines toward the administration of these agents will lead to more efficient and safer pain management in this setting.

 
Keyword(s): ADVERSE DRUG EVENTS, HEPATIC CIRRHOSIS, PAIN MANAGEMENT, ACETAMINOPHEN
 
References: 
  • ندارد
 
  pdf-File tarjomyar Yearly Visit 133
 
Latest on Blog
Enter SID Blog