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Over-the-counter Analgesics Appear to Have Little Impact on Worsening Condition of Cirrhosis Patients: Presented at AASLD

By Ed Susman

BOSTON, MA -- November 6, 2003 -- Patients with liver cirrhosis do not appear to worsen their condition by taking over-the-counter analgesics such as acetaminophen or non-steroidal anti-inflammatory drugs, researchers reported here October 30^th at the 54^th Annual Meeting of the American Association for the Study of Liver Diseases.

"Interestingly, we found that cirrhotic patients ingest significantly less over-the-counter analgesics than non-cirrhotic controls," said Sakib Khalid, PhD, post-doctoral fellow in gastroenterology, Yale University, New Haven, Connecticut, United States. "The ingestion of low quantities of over-the-counter analgesics below recommended dosages does not play a role in the decompensation of cirrhosis."

Dr. Khalid noted in his poster presentation, however, "as expected, alcohol is an important contributor to decompensation in alcoholic cirrhosis."

Dr. Khalid and his colleagues undertook the prospective study because over-the-counter analgesics can theoretically lead to decompensation of cirrhosis. "Acetaminophen, an intrinsic hepatotoxin, would do so by producing an acute or chronic liver injury, particularly in the setting of chronic alcohol consumption," Dr. Khalid explained. He said, "the non-steroidal anti-inflammatory drugs could cause -- in theory – decompensation, by blunting the response to diuretics and/or by promoting renal vasoconstriction."

The role of the drugs in precipitating the decompensation of cirrhosis had not been previously investigated, Dr. Khalid said.

During the period between August 2000 and May 2002, the researchers interviewed 91 cirrhotic patients who were admitted consecutively for decompensation of cirrhosis -- suffering from such conditions as variceal hemorrhage, ascites, encephalopathy, jaundice, spontaneous bacterial peritonitis or other infections, and/or renal dysfunction. These cases were compared to 153 consecutive cirrhotic patients seen in the outpatient liver clinic in the same period, who had not been hospitalised either in the previous 3 months nor 30 days after inclusion into the study. A second control group of 89 randomly selected non-cirrhotic patients concurrently hospitalised with the cases was added to account for recall bias.

All patients underwent a structured questionnaire that asked about drug and alcohol use, as well as detailed information regarding all medications, including over-the-counter analgesic use -- quantity, frequency, and type of preparation, and alcohol ingestion.

Dr. Khalid found that 35% of the patients hospitalised for cirrhotic decompensation used over-the-counter analgesics in the past 30 days compared to 53% of non-decompensated cirrhotics and 70% of non-cirrhotic controls. The difference between the decompensated cirrhotics and the controls reached significance at the P < .001 level.

The researchers found that 19% of the patients hospitalised for cirrhotic decompensation used acetaminophen in the past 30 days compared to 26% of non-decompensated cirrhotics and 42% of non-cirrhotic controls. The difference between the decompensated cirrhotics and the controls reached significance at the P = .001 level.

It was also found that 15% of the patients hospitalized for cirrhotic decompensation used NSAIDs in the past 30 days compared with 31% of non-decompensated cirrhotics and 34% of non-cirrhotic controls. The difference between the decompensated cirrhotics and the controls reached significance at the P = .001 level.

On the other hand, Dr. Khalid noted that 28% of the patients hospitalised for cirrhotic decompensation used alcohol in the past 30 days compared with 20% of non-decompensated cirrhotics and 33% of non-cirrhotic controls. Those differences were not statistically different.

But the amount of alcohol consumed by each group was significant. Among patients hospitalised for cirrhotic decompensation, an average of 532 grams of alcohol was consumed in the past 30 days compared with 60 grams consumed on average among non-decompensated cirrhotics and 28 grams of alcohol consumed on average by the non-cirrhotic controls. The difference between the decompensated cirrhotics and the controls reached significance at the P < .001 level.

This study was partially supported by a grant from McNeil Pharmaceuticals.


[Study Title: Do Over-the-Counter Analgesics Contribute to Decompensation of Cirrhosis? A Prospective Study. Abstract 1127]

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