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Analgesia in cirrhosis — GPhC CRA MCQ

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HardRenal and Hepatic ImpairmentAnalgesia in cirrhosisGPhC CRA

A 58-year-old man with decompensated cirrhosis asks to buy co-codamol for back pain. He has ascites, takes lactulose for encephalopathy and drank alcohol heavily until last month. What is the most appropriate alternative?

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Correct answer: E — Refer for clinician advice and avoid OTC codeine-containing analgesics

Cirrhosis with encephalopathy and ascites requires careful analgesic selection. Codeine can worsen constipation and encephalopathy risk, while NSAIDs can precipitate renal impairment and gastrointestinal bleeding in cirrhosis. Paracetamol may be used at reduced doses in some patients, but this patient needs clinician-specific advice. OTC supply of co-codamol would be unsafe.

Reference: BNF; NICE CKS Cirrhosis