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NSAIDs in liver cirrhosis — GPhC CRA MCQ

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ModerateHepatic Dose AdjustmentNSAIDs in liver cirrhosisGPhC CRA

A 52-year-old woman with chronic hepatitis C and compensated cirrhosis presents with a prescription for naproxen 500 mg twice daily for musculoskeletal pain. What is the most appropriate action?

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Correct answer: C — Contact the prescriber as NSAIDs should be avoided in patients with liver cirrhosis due to the risk of GI bleeding, renal impairment, and fluid retention

NSAIDs are best avoided in patients with liver cirrhosis due to multiple risks: increased GI bleeding (especially from oesophageal varices), renal impairment (hepatorenal syndrome), fluid retention, and sodium retention exacerbating ascites. The BNF advises avoiding NSAIDs in hepatic impairment. The prescriber should be contacted to discuss safer alternatives such as paracetamol at reduced doses or non-pharmacological approaches.

Reference: BNF; NICE CKS Cirrhosis