Medication Safety

Most medicines are processed through the liver and kidneys. So, it’s important to think about safety when you are taking medicine, especially when you have liver or kidney disease.

Know the names of your medicines and what they are used for. Bring a list of them and the doses to appointments with your healthcare team. Without this information, it will be difficult and possibly even unsafe to make changes in your treatment.

Always take your medicine as prescribed and let your health care team know if you are taking over-the-counter or herbal medicines. If you are not sure if something is safe, please ask a member of your healthcare team, like your pharmacist.

Below you can find information for people with cirrhosis, on some common medications.

Non-steroidal Anti-inflammatory Drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs (or NSAIDs) are medicines used to treat pain. Some examples of NSAIDs are ibuprofen, Motrin, Advil, Naproxn and Aleve. You should avoid NSAIDs if you have cirrhosis, especially if you have problems with ascites or fluid build-up. They can cause serious problems with your kidneys and increase your risk of bleeding.

Acetaminophen (Tylenol®)

If you have cirrhosis, you may have been told not to take acetaminophen. But, you actually can as long as you keep the dose to less than 2000 milligrams a day and don’t drink alcohol. You can take up to 4 extra strength acetomentophen in a day, as long as they only have 500mg in each pill. You should always read the medicine label. If you follow these guidelines, acetaminophen is actually safer than most other pain medicines.

Opioids

Narcotics and opioids are usually used to treat pain. Some examples are codeine, morphine and fentanyl. Taking these medicines when you have cirrhosis is complicated, and can be dangerous, and it’s best to avoid them.

Sedatives

Benzodiazepines are a type of medicine used to treat anxiety. Some examples are Ativan or valium. They can make you feel really sleepy if you have cirrhosis. It’s best to avoid them or take them as little as possible. Even over-the-counter medicines like Benadryl, which is used for itching and allergies, or Gravol, for nausea, can cause too much sleepiness. If you need to take these medicines, try taking a lower dose for a limited period of time.

Cold and Flu Medications

Many over the counter medicines for colds and flus contain more than one drug. Some contain NSAIDs, which you shouldn’t take. Others have decongestants and antihistamines that can make you drowsy. Remember to read medication labels so you know what’s in them before you take them.

Herbal Medicines

The small amounts of herbs used in cooking don’t usually cause health problems. But, herbal medicines can be risky, because they contain more concentrated and larger amounts of herbs.

Milk thistle is a common herbal medicine that people with liver disease might be interested in. Studies haven’t proved that it helps the liver, but it’s generally considered safe, although it can have side effects like diarrhea and bloating.

Remember that just because something is “natural” doesn’t mean it’s safe. Most herbal medicines have not been studied in people with cirrhosis, and some have been found to be toxic for the liver.  Also, herbal medicines can interact with other medications you’re taking.

References:

The information on this page was adapted (with permission) from the references below, by the Cirrhosis Care Alberta project team (physicians, nurse practitioners, registered nurses, registered dietitians, physiotherapists, pharmacists, and patient advisors).

This information is not intended to replace advice from your healthcare team. They know your medical situation best. Always follow your healthcare team’s advice.

References: 

  1. US Department of Veterans Affairs, Veterans Health Administration 
  2. Canadian Liver Foundation
Last reviewed March 15, 2021
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