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Analgesia in cirrhosis — GPhC CRA MCQ

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HardRenal and Hepatic ImpairmentAnalgesia in cirrhosisGPhC CRA

A 68-year-old woman with cirrhosis from alcohol-related liver disease asks for pain relief for osteoarthritis. She takes carvedilol and lactulose and had an upper GI bleed last year. She asks specifically for ibuprofen because paracetamol worries her. What is the most appropriate alternative?

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Correct answer: B — Discuss cautious low-dose paracetamol and avoid NSAIDs unless specialist advised

In cirrhosis, NSAIDs can precipitate renal impairment, fluid retention and GI bleeding, particularly with a prior bleed. Paracetamol may be used cautiously at reduced dose depending on clinical circumstances and alcohol intake, but needs careful advice. The pharmacist should avoid routine NSAID sale and signpost for pain review.

Reference: BNF; NICE CKS