Internal Medicine

Pain relievers for liver diseases

There are a variety of diseases of the liver that are associated with different symptoms. Here, however, it is particularly important to take the correct medication intake, because the liver is the central metabolic organ of humans and is responsible, among other things, for the breakdown of medicinal toxins.

Some drugs have a harmful effect on the liver and, in the worst case, can seriously damage it and even lead to liver failure and thus death. So it is very important to take the “right” pain relievers when you have liver disease.

To relieve the liver, drugs can be chosen that are eliminated via the kidney. However, this presupposes that the kidneys are sufficiently functional. If this is also damaged, the dose must also be adjusted here.

Read about this too: Pain relievers for kidney disease

These pain relievers are beneficial for liver disease

In general, it is important to know that almost every medication package insert states that this can be harmful to the liver, because the active ingredients are broken down by the liver. If you have liver disease, you should always consult your doctor about which pain reliever you can take.

When choosing pain relievers, metamizole (e.g. Novalgin) is usually given, as Novalgin is mainly excreted via the kidneys and can therefore be used better than other drugs in the case of hepatic insufficiency.

Read more at: Novalgin

Novalgin

Novalgin can be taken more easily than paracetamol or drugs from the group of NSAIDs if the liver function is impaired. The liver toxic effect is significantly less.

According to the package insert, multiple, high doses should not be taken if the liver function is impaired. In the case of short-term use, however, the dose does not have to be reduced and Novalgin can be taken despite impaired liver function.

These painkillers are not good for liver disease

There is a list of medications that could cause problems if you have liver disease or advanced liver failure.

The following are the most popular and commonly used drugs. However, it should be pointed out that a drug that is potentially harmful to the liver does not necessarily lead to liver damage.

Depending on the diagnosis, certain medications must be taken despite possible side effects. In any case, the medication intake must be discussed with the doctor.

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Hepatic insufficiency
Liver pain

Paracetamol

Paracetamol is the drug that can cause most liver damage. Therefore, it should not be taken without a doctor's consultation, even if the liver is already ill.

The fatal thing is that paracetamol, in small amounts, is the best tolerated pain reliever and, for example, it is also the drug of choice for pregnant women due to its low side effects. The disadvantage, however, is the hepatotoxic effect of an overdose, which is why it is essential to pay attention to the maximum dose.

If the liver has already been damaged, paracetamol has a hepatotoxic effect at a dose of approx. 6 g.
Symptoms of paracetamol overdose are Nausea, paleness, loss of appetite or Abdominal pain. If you see these signs, you should see a doctor immediately, as liver damage from paracetamol can be life-threatening.

NSAIDs

All non-steroidal anti-inflammatory drugs (NSAIDs) can damage the liver. The best-known drugs include ibuprofen, ASA or diclofenac.

For each of these drugs, the instruction leaflet indicates that they should not be taken if the liver is damaged. As with other NSAIDs, ibuprofen, ASA (aspirin) or diclofenac can cause the levels of one or more liver enzymes to increase.

You may also be interested in the following article: NSAIDs nonsteroidal anti-inflammatory drugs

aspirin

Aspirin is an acetyl salicylate and belongs to the group of non-steroidal anti-inflammatory drugs.

It reduces inflammation and fever and has an influence on blood clotting. Aspirin, which belongs to the group of NSAIDs, is also contraindicated in acute liver failure. The liver-damaging effect is, however, significantly less than that of paracetamol.

Also read:

aspirin
Painkiller

Morphine

Morphine is a strong pain reliever from the opioid group. It is mainly taken for very severe pain and requires a prescription. So it is not suitable for mild forms of pain.

It is important that the doctor individually adjusts the dose to the patient in each case. In the case of impaired liver function, morphine should only be taken in exceptional cases and after consulting a doctor. The problem with taking it despite liver failure is that both the effect of the morphine and the half-life can increase.

Please also read: Side effects of morphine

What other drugs increase liver damage? Antibiotics?

Antibiotics

Most antibiotics can also be taken in the case of liver disease after consulting a doctor, as they are nevertheless well tolerated.

However, there are some exceptions such as cotrimoxazole. This antibiotic should not be taken if the liver or kidney is damaged.

Antidepressants

Caution should also be exercised with most antidepressants, as they are broken down with a delay in hepatic insufficiency and the effect can thus change.

An example of this is fluoxetine, an antidepressant from the group of selective serotonin reuptake inhibitors that is very often prescribed for depression or obsessive-compulsive disorder.

If you have liver disease, your doctor may need to adjust the dose of the drug to avoid side effects. This also applies to drugs from the group of tricyclic antidepressants (e.g. Imipramin-neuraxpharm).

Also read: Drugs for depression, side effects of antidepressants

Antihistamines

In the case of drugs from the group of antihistamines, there are some active ingredients that should be used with caution in the event of severe liver dysfunction.

For example, when taking Loratadine a consultation with the attending physician take place. This also applies to Terfenadinewhich is an absolute contraindication in the case of significantly impaired liver function.

Please also read the following article: Antihistamines

Beta blockers

In the case of beta blockers, a few drugs have to be adjusted in their dose in the event of acute liver damage. Examples are metoprolol or Inderal from the group of beta-adrenoceptor antagonists.

Also read: Beta blockers

Lopermid

Loperamide or Imodium are motility inhibitors that are taken for the symptomatic treatment of diarrhea.In patients with impaired liver function, these should be consumed with caution and patients should be monitored closely for CNS damage.

Here, too, as with any drug in the case of an existing liver disease, the intake should be clarified beforehand by a doctor.

What can I do to minimize the damage the pain medication does to the liver?

Almost all drugs are broken down by the liver, which makes it difficult to choose the right pain reliever for liver disease. Still, toxic liver damage is very rare with the correct dosage.

In any case, it is important to consult with the doctor so that the dose can be adjusted individually and an overdose is avoided.
You should also always read the information leaflet of the medication carefully and also pay attention to interactions with other medications. Some pain relievers should not be combined with other preparations, including natural remedies.
Furthermore, factors such as obesity or alcohol consumption worsen the liver values. If you have liver disease, you should definitely pay attention to the right and healthy diet and avoid alcohol.
The use of homeopathic remedies, such as milk thistle, is also discussed in the literature. Milk thistle protects the liver and helps relieve liver disorders and weakness. It is also used for alcohol and drug poisoning and can have a positive effect on the damage to the liver caused by pain medication.

Nevertheless, a disease of the liver should always be examined by a specialist and the treatment options discussed. If you feel that you have not used the correct dose of pain reliever, or if you show signs of drug intoxication, you should see a doctor immediately.

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