Painkillers and the Liver

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Painkillers and the Liver

One of the most common questions that I am asked by my patients with

hepatitis or other liver diseases is - " Which type of painkiller is safer

for my liver - acetaminophen (Tylenol), or nonsteroidal anti-inflammatories

(such as Aspirin, or Motrin)? " - Well, in this brief article which is

excerpted from my book : " Dr. Palmer's Guide To Hepatitis and Liver

Disease " I will answer this question.

Acetaminophen ( APAP or Tylenol) is a medication used to control pain

known as an analgesic ) and fever ( known as an antipyretic ). It does this

without producing the stomach discomfort often experienced with aspirin and

other nonsteroidal anti-inflammatories (NSAIDs). This capability has caused

acetaminophen to become a very popular alternative to NSAIDs. In small doses

(i.e. less than four grams per day, or eight pills taken over a twenty-four

hour period of time) acetaminophen is quite safe for the liver. ( Note :

each acetaminophen tablet or pill typically contains 500mg of

acetaminophen). In fact, acetaminophen is the recommended medication for

relieving minor aches, pains and headaches from any cause in individuals

with liver disease.

However, when taken in excessive quantities or when combined with alcohol,

acetaminophen may cause death due to liver failure. In fact, an overdose of

acetaminophen is one of the most common causes of liver failure, as well as

the most common cause of drug-induced liver disease in the United States.

And, after acetaminophen became readily available in 1960 as an over-the-

counter medication, it became one of the most popular instrumentality's for

attempting suicide.

For liver injury to occur, acetaminophen must generally be consumed in a

quantity exceeding fifteen grams within a short period of time, such as in a

single dose. Although uncommon, an ingestion of between seven to ten grams

at one time may also cause liver damage. The consumption of alcohol in

conjunction with acetaminophen significantly increases the likelihood that

an individual will incur severe liver damage. Therefore, individuals who

consume alcohol on a regular basis should probably limit acetaminophen

intake to a maximum of one to two grams per day ( i.e. two to four pills

within a twenty-four hour period). Still, the best advise for individuals

with liver disease is to totally abstain from alcohol.

Individuals should take special note that acetaminophen is also an active

ingredient in more than two hundred other medications, including Nyquil and

Anacin 3. So, it is essential to carefully read the labels of all over-the-

counter medications carefully. Other commonly used medications such as

omeprazole ( Prilosec), phenytoin ( Dilantin), and isoniazid (INH) may

increase the risk of liver injury caused by acetaminophen. It is always in

the liver patient's best interests to consult with his or her hepatologist

prior to taking any medication.

Acetylsalicylic acid (Aspirin) and other NSAIDs are drugs which are widely

used for their anti-inflammatory and analgesic effects. They also have the

potential to cause drug-induced liver disease. In fact, many NSAIDs have

been withdrawn from the market due to their harmful effects on the liver

known as hepatotoxicity). All NSAIDs have the potential to cause liver

injury. However, some NSAIDs are more hepatotoxic than others. The NSAIDs

which are presently on the market, yet are frequently associated with liver

injury are: aspirin (ASA), diclofenac (Voltaren), and sulindac (Clinoril).

Therefore, individuals with liver disease should avoid using these NSAIDs.

Older women seem to be particularly susceptible to the hepatotoxicity of

NSAIDs, and are best advised to avoid NSAIDs altogether. Individuals who

have developed complications of cirrhosis, (known as decompensated

cirrhosis), such as ascites ( accumulation of fluid in the abdomen) or

bleeding esophageal varices ( enlarged blood vessels in the esophagus), are

at increased risk for kidney injury due to NSAIDs. Since this may lead to

both liver and kidney failure, known as hepatorenal syndrome, individuals

with advanced liver disease are best advised to totally avoid all NSAIDs.

In conclusion, acetaminophen taken in moderate dosages is generally the

safer choice for the relief of minor aches and pains occurring in

individuals with any type of hepatitis or liver disease.

Reprinted with permission of the author Palmer, MD from the book

" Dr. Palmer's Guide To Hepatitis and Liver Disease " . © Copyright

Palmer, MD 2000

copyright © 2000 Palmer, MD