title: The Prescription Pattern of Acetaminophen and Non-Steroidal Anti-Inflammatory Drugs in Patients with Liver Cirrhosis.
abstract: Analgesics, known to be hepatotoxic drugs, are frequently prescribed to patients with liver cirrhosis who are prone to drug-induced liver injury. No guidelines are available regarding the prescription of analgesics in these patients. Therefore, we aimed to evaluate the prescription pattern of most frequently used analgesics in patients with cirrhosis. We assessed the prescription pattern of acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) in patients with liver cirrhosis registered in Health Insurance Review Assessment Service database between January 1, 2012 and December 31, 2012. A total of 125,505 patients with liver cirrhosis were registered from January 1, 2012 to December 31, 2012. Of that group, 50,798 (40.5%) patients claimed reimbursement for at least one prescription for acetaminophen or NSAIDs during the one year follow-up period. Overall, NSAIDs (82.7%) were more prescribed than acetaminophen (64.5%). NSAIDs were more prescribed than acetaminophen even in decompensated cirrhosis compared with compensated cirrhosis (71.5% vs. 68.8%, P value < 0.001). There was a marked difference in prescription preference between acetaminophen and NSAIDs among physicians. Internists more frequently prescribed acetaminophen than NSAIDs compared to other physicians (50.9% vs. 76.2%, P < 0.001). Gastroenterologists more frequently prescribed acetaminophen over NSAIDs compared to other internists (80.9% vs. 51.2%, P < 0.001). Analgesics were prescribed in 40.5% of patients with cirrhosis. NSAIDs were more frequently prescribed although they should be avoided. The prescription pattern of analgesics were different significantly among physicians in patients with liver cirrhosis. The harmful effects of NSAIDs in patients with cirrhosis should be reminded to all physicians prescribing analgesics.
authors.affiliation: Department of Internal Medicine, College of Medicine Pusan National University, Liver Center, Research Institute of Convergence for Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Young Mi
authors.identifier: http://orcid.org/0000-0001-5427-7505
authors.initials: YM
authors.lastname: Hong
authors.affiliation: Department of Internal Medicine, College of Medicine Pusan National University, Liver Center, Research Institute of Convergence for Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Ki Tae
authors.identifier: http://orcid.org/0000-0002-8580-0239
authors.initials: KT
authors.lastname: Yoon
authors.affiliation: Digestive Disease Center, Pusan National University Hospital, Busan, Korea.
authors.forename: Jeong
authors.identifier: http://orcid.org/0000-0003-0961-7851
authors.initials: J
authors.lastname: Heo
authors.affiliation: Digestive Disease Center, Pusan National University Hospital, Busan, Korea.
authors.forename: Hyun Young
authors.identifier: http://orcid.org/0000-0002-0605-6318
authors.initials: HY
authors.lastname: Woo
authors.affiliation: Digestive Disease Center, Pusan National University Hospital, Busan, Korea.
authors.forename: Won
authors.identifier: http://orcid.org/0000-0001-7746-9286
authors.initials: W
authors.lastname: Lim
authors.affiliation: Research and Statistical Support, Research Institute of Convergence for Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Dae Seong
authors.identifier: http://orcid.org/0000-0003-4384-5559
authors.initials: DS
authors.lastname: An
authors.affiliation: Research and Statistical Support, Research Institute of Convergence for Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Jun Hee
authors.identifier: http://orcid.org/0000-0001-5736-8752
authors.initials: JH
authors.lastname: Han
authors.affiliation: Department of Internal Medicine, College of Medicine Pusan National University, Liver Center, Research Institute of Convergence for Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea. mcho@pusan.ac.kr.
authors.forename: Mong
authors.identifier: http://orcid.org/0000-0002-0498-6300
authors.initials: M
authors.lastname: Cho
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects / Q000627:therapeutic use*; D000368:Aged; D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology; D016208:Databases, Factual; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006525:Hepatitis, Viral, Human / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012042:Registries
chemical_list: D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000082:Acetaminophen
keywords: Acetaminophen; Liver Cirrhosis; Non-Steroid Anti-Inflammatory Drugs (NSAIDs); Pattern of Prescription