Page 9 - EADS Scientific Magazine .... 1st Edition

Analgesics and cirrhosis
Analgesics and cirrhosis

Cirrhosis is the one most common cause of death all over the world . Patients
with advanced chronic liver failure(cirrhosis) take numerous complications in

many biological systems including blood disorders, gastrointestinal diseases ,

gynecomastia and testicular atrophy, albumin and cholesterol metabolism
disorders, The liver may not be able to metabolize the waste products, resulting

in elevated blood ammonia levels and hepatic encephalopathy (lethargy, confu-
sion, coma). So medications may be required to control the amount of protein

absorbed in the diet.

Analgesics and cirrhotic patient:

1) acetaminophen is the ButThis risk is directly In the presence of GSH,

preferred analgesic in related to the satura- NAPQI is conjugated

patients with liver dis- tion of other metabolic and excreted renally.
ease who are not actively pathways and depletion When GSH is unavail-

drinking, and it may be of glutathione (GSH) able, NAPQI accumu-

dosed up to 2 to 3 g/day. stores Approximately lates and causeshep-
However it is commonly 5% of acetaminophen is atocyte necrosis and

believed that acetamin- metabolized by CYP450 apoptosis. Alcoholics

ophen should be avoid- enzymes to the reac- may develop a CYP2E1
ed in liver dysfunction tive metabolite N-ace- induction

patients due to its well- tyl-pbenzoquinone and have decreased

known hepatotoxicity imine (NAPQI). GSH levels from mal-

risk in overdose, nutrition and which
makecontraindecated .

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

In cirrhotic patients, alterations in metabolism and bioavailability are expected
with NSAIDs. These drugs inhibit prostaglandin synthesis leading to decreased

renal blood flow and glomerular filtration rate (GFR) and impaired renal so-
dium and water excretion, which may worsen ascites and increase the risk of

hepatorenal syndrome in cirrhosis patients.and also may cause gastrointesti-
nal irritation, ulceration, and perforation and increase patients’ overall risk of

bleeding due to inhibition of platelet thromboxane A2 production And also For
these reasons, NSAIDs should be avoided in cirrhosi