title: Use of over-the-counter analgesics in patients with chronic liver disease: physicians' recommendations.
abstract: BACKGROUND
  Over-the-counter analgesics (OTCAs), principally paracetamol (acetaminophen)-containing compounds and NSAIDs, are commonly used medications. Guidelines for the use of these agents in patients with chronic liver disease (CLD) are not available, despite the possibility that such patients may be more susceptible to the effects of an adverse reaction. Notwithstanding the lack of guidelines for healthcare providers, patients are often counselled to modify their use of these drugs. Therefore, the primary aim of this study was to assess healthcare providers' recommendations on how OTCAs should be used by patients with CLD.
  
  
  METHODS
  An 11-question web-based survey was distributed via email to healthcare providers participating in four healthcare networks in the US, to determine what recommendations they make to patients with cirrhosis (compensated and decompensated) and chronic hepatitis regarding the use of paracetamol and NSAIDs. Healthcare providers were also queried about the recommendations they make to patients with cirrhosis regarding pain control, and on the use of paracetamol for patients who consume alcohol daily.
  
  
  RESULTS
  Overall, a 12% response rate was obtained. Internal medicine, family practice, paediatrics, and gastroenterology were the most represented practice types. Recommendations against the use of NSAIDs were significantly less common than recommendations against paracetamol use, in cases of both compensated and decompensated cirrhosis (p = 0.001). Non-gastroenterologists and non-primary care physicians were the least likely to recommend against NSAID use (p = 0.001), while gastroenterologists were the least likely to recommend against paracetamol in these patients (p = 0.001). It was the recommendation of most respondents that OTCAs should be avoided in patients with cirrhosis, and that paracetamol should be avoided or its dose reduced in the setting of daily alcohol use.
  
  
  CONCLUSIONS
  Significant variability exists among healthcare providers on their recommendations for OTCA use in the setting of chronic liver disease. Non-gastroenterologists are more likely to recommend against the use of paracetamol than NSAIDs, and patients with chronic liver disease may be under-treated for pain.
authors.affiliation: Thomas Jefferson University Hospital and Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
authors.forename: Simona
authors.initials: S
authors.lastname: Rossi
authors.forename: David N
authors.initials: DN
authors.lastname: Assis
authors.forename: Monica
authors.initials: M
authors.lastname: Awsare
authors.forename: Mark
authors.initials: M
authors.lastname: Brunner
authors.forename: Kevin
authors.initials: K
authors.lastname: Skole
authors.forename: Jitha
authors.initials: J
authors.lastname: Rai
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Andrel
authors.forename: Steven K
authors.initials: SK
authors.lastname: Herrine
authors.forename: Rajender K
authors.initials: RK
authors.lastname: Reddy
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Navarro
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects / Q000627:therapeutic use; D000428:Alcohol Drinking / Q000009:adverse effects; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D002908:Chronic Disease; D000075202:Contraindications; D006801:Humans; D020407:Internet; D008107:Liver Diseases / Q000150:complications*; D004366:Nonprescription Drugs / Q000009:adverse effects / Q000627:therapeutic use; D010146:Pain / Q000150:complications / Q000188:drug therapy; D010820:Physicians / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004366:Nonprescription Drugs; D000082:Acetaminophen