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Paracetamol in hepatic impairment — GPhC CRA MCQ

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HardGI TherapeuticsParacetamol in hepatic impairmentGPhC CRA

A 70-year-old man with chronic liver disease (Child-Pugh B) presents a prescription for paracetamol 1g four times daily. He weighs 60 kg. What is the most appropriate action?

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Correct answer: E — Contact the prescriber to reduce the dose or frequency, as hepatic impairment increases the risk of paracetamol hepatotoxicity

In patients with significant hepatic impairment, the capacity for paracetamol metabolism via glucuronidation and sulphation may be reduced, increasing the proportion metabolised via the CYP2E1 pathway to the hepatotoxic metabolite NAPQI. The BNF advises caution with paracetamol in hepatic impairment and the dose should not exceed 3g daily in patients with risk factors including chronic liver disease, low body weight, or chronic alcohol use. The prescriber should be contacted to discuss dose reduction.

Reference: BNF Paracetamol; NICE CKS