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Paracetamol in liver cirrhosis — GPhC CRA MCQ

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ModerateHepatic Dose AdjustmentParacetamol in liver cirrhosisGPhC CRA

A 68-year-old man with liver cirrhosis (Child-Pugh C) presents with a prescription for paracetamol 1 g four times daily for chronic pain. What is the most appropriate action?

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Correct answer: A — Contact the prescriber to discuss reducing the dose or frequency, as paracetamol should be used with caution and at reduced doses in severe hepatic impairment

Paracetamol can be used in liver disease but with caution. In severe hepatic impairment, the maximum dose should be reduced (typically to a maximum of 2 g per day, with longer dosing intervals). The risk of hepatotoxicity is increased in patients with liver cirrhosis, chronic alcohol use, and malnutrition. NSAIDs are contraindicated in liver cirrhosis due to risks of GI bleeding and renal impairment. The prescriber should be contacted to discuss dose reduction.

Reference: BNF