Pain Management with Acetaminophen in Patients with Liver Diseases: A Review Article

Context: Pain management is essential for all patients, including those with liver diseases. Opiates should be used with caution in patients with liver diseases as they are well-known for constipation, sedation, and precipitation of encephalopathy. Meanwhile, the principal fear of the use of non-steroidal anti-inflammatory drugs (NSAIDs) in liver disease is the danger of hastening renal impairment. Thus, acetaminophen is considered first-line therapy because of the side effects of other analgesics. However, there is an assumption that patients with chronic liver disease may be in danger when consuming the drug at therapeutic doses. Methods: Data were extracted from 33 papers. All articles were published until July 2020. The search was done using the following keywords: acetaminophen, paracetamol, cirrhosis, liver disease, chronic hepatitis, and safety in reliable databases. A total of 414 articles were selected some of which were excluded owing to irrelevance, studies on animals and the lack of access to the full text. Results: Cirrhotic patients could safely take acetaminophen in adjusted doses. Although acetaminophen was safely administered in therapeutic doses in alcoholic patients, there were reports of hepatotoxicity even in therapeutic doses. Acetaminophen was not recommended in patients with acute hepatitis but could be safely used in patients with chronic hepatitis. Patients with non-alcoholic fatty liver disease (NAFLD) were susceptible to acetaminophen toxicity. Conclusions: In spite of the conception that acetaminophen has dire consequences in liver disease, it can be safely administered in adjusted doses in most liver diseases.