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NSAIDs in cirrhosis — GPhC CRA MCQ

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HardRenal and Hepatic ImpairmentNSAIDs in cirrhosisGPhC CRA

A patient with decompensated cirrhosis, ascites and rising creatinine takes spironolactone and furosemide and requests ibuprofen for shoulder pain. What is the best response?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: BDo not sell an NSAID; arrange clinical analgesic review

In decompensated cirrhosis, NSAIDs can reduce renal perfusion, promote sodium and fluid retention, worsen ascites and add gastrointestinal/variceal bleeding risk. Rising creatinine and concurrent diuretics make an OTC sale especially unsafe. Food or a PPI cannot remove renal and haemodynamic toxicity, and changing diuretics or substituting another NSAID/aspirin without clinical review is inappropriate.

Reference: SPS: medicines in liver disease. https://www.sps.nhs.uk/articles/liver-disease-podcast-series/