title: Acute effects of dipyrone on renal function in patients with cirrhosis: a randomized controlled trial.
abstract: Use of non-steroidal anti-inflammatory drugs in cirrhosis has been associated with impairment of renal function based on its ability to inhibit the renal production of prostaglandins. Renal effects of dipyrone in patients with cirrhosis have not been evaluated. We aimed to assess the renal effect of therapeutic doses of dipyrone used for short periods of time in patients with cirrhosis. Twenty-nine patients with cirrhosis were included in an observer-blind clinical trial. Patients were randomized to receive three times a day oral acetaminophen (500 mg; N = 15) or dipyrone (575 mg; N = 14) for 72 hr. Serum and urine samples were obtained at baseline, 48 and 72 hr, and cystatin C, creatinine, aldosterone, 6-keto-Prostaglandin-F1 alpha and prostaglandin E2 were measured. Cystatin C and creatinine levels remained comparable in patients treated with acetaminophen and dipyrone. Urine and serum prostaglandins concentrations were significantly decreased at 72 hr in patients treated with dipyrone regardless of the status of ascites. One patient with ascites treated with dipyrone required a paracentesis and developed renal insufficiency. We conclude that dipyrone and acetaminophen did not reduce renal function when used for short periods of time (up to 72 hr) in patients with cirrhosis. However, considering that dipyrone lowered renal vasodilator prostaglandins synthesis, acetaminophen appears as the safest choice with respect to kidney function in cirrhosis.
authors.affiliation: CIBERehd, Institute of Health Carlos III, Madrid, Spain; Unit of Clinical Pharmacology, University General Hospital, Alicante, Spain; Institute of Bioengineering, University Miguel Hernandez, Alicante, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Zapater
authors.forename: Lucia
authors.initials: L
authors.lastname: Llanos
authors.forename: Claudia
authors.initials: C
authors.lastname: Barquero
authors.forename: Pablo
authors.initials: P
authors.lastname: Bellot
authors.forename: Sonia
authors.initials: S
authors.lastname: Pascual
authors.forename: Fernando
authors.initials: F
authors.lastname: Carnicer
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Palazón
authors.forename: Paula
authors.initials: P
authors.lastname: Gimenez
authors.forename: Angel
authors.initials: A
authors.lastname: Esteban
authors.forename: Lourdes
authors.initials: L
authors.lastname: Llorca
authors.forename: Ruben
authors.initials: R
authors.lastname: Francés
authors.forename: Jose Francisco
authors.initials: JF
authors.lastname: Horga
authors.forename: Jose
authors.initials: J
authors.lastname: Such
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001201:Ascites / Q000188:drug therapy; D004177:Dipyrone / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007668:Kidney / Q000187:drug effects*; D007677:Kidney Function Tests; D008103:Liver Cirrhosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011453:Prostaglandins / Q000378:metabolism*; D016037:Single-Blind Method; D013997:Time Factors
chemical_list: D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D011453:Prostaglandins; D000082:Acetaminophen; D004177:Dipyrone