Acetaminophen (Tylenol™): The preferred pain reliever. Is generally thought to be safe in patients with liver disease in doses up to 2000mg in a 24-hour period. Make certain that you check all medications for acetaminophen and APAP [another name for acetaminophen].
Acetaminophen & Hydrocodone (Vicodin™, Lorcet™, Lortab™, Percoset™…): Is safe in most liver patients.
Acetaminophen & Propoxyphene (Darvocet™): At regular doses provides limited benefit, not much different than acetaminophen alone. Higher doses are a major cause of drug related deaths. On November 19, 2010, the FDA banned all sale of Darvon and Darvocet. It interferes with heart function, causes confusion and seizures.
Codeine: Many people have trouble metabolizing codeine resulting in nausea, vomiting or confusion. Liver patients cannot metabolize codeine to its active form (morphine).
Duloxetine (Cymbalta™): Is problematic for liver patients causing constipation, sedation, weight gain and confusion.
Fentanyl Patch: Is a strong medication but causes less nausea, confusion and constipation.
Gabapentin (Neurontin™, Lyrica™): Are safe in liver patients
Hydromorphone (Dilaudid™): Can be used short term for severe pain.
Lidoderm Patches: Work well for local pain.
Methadone: Can be helpful but must be monitored closely in Liver patients.
Meperidine (Demerol™): Has many neurological side effects including seizures. If used, it should be limited to use during surgical procedures only.
Morphine: is difficult for liver patients to process and may cause seizures, confusion and respiratory problems and decreased blood pressure.
NSAIDS (Ibuprofen, Motrin™, Advil™ …): Are a problem for liver patients. And have been frequently associated with liver injury. Hep C patients have an increased risk for major liver damage from NSAIDS may cause salt and water retention and may worsen edema and ascites. Varices may worsen and life-threatening bleeding may occur. Patients with severe liver disease may suffer from kidney damage from NSAIDS. Note; some heart patients may have to use aspirin therapy, make certain that your liver doctor is aware of all meds you are taking.
Tramadol (Ultram™): works well for liver patients but should not be used with some antidepressants. The combination can cause seizures.
Dr Pate is a psychiatrist that specializes in patients with Liver disease. Half of her patients have Hep C and the other half are waiting for a transplant. She has a private practice in Houston.