Rorat Marta J, Szymański Wojciech, Zińczuk Aleksander
Department of Social Sciences and Infectious Diseases, Medical Faculty, Wroclaw University of Science and Technology, Wroclaw, Poland.
1 Department of Infectious Diseases, J. Gromkowski Specialist Regional Hospital, Wroclaw, Poland.
Clin Exp Hepatol. 2025 Jun;11(2):113-120. doi: 10.5114/ceh.2025.151745. Epub 2025 Jun 25.
Safe and effective pain treatment for patients with chronic liver diseases (CLD) often poses a challenge in clinical practice. The widespread use of painkillers can lead to drug-induced liver injury. CLD can alter drug response by affecting drug-metabolizing enzymes and half-life, thereby impacting the strength and safety of drug use. This study reviews the safety and hepatotoxicity of selected analgesics in CLD. Paracetamol is the safest drug when used in standard doses. Metamizole is not contraindicated for short-term treatment. Non-steroidal anti-inflammatory drugs should be avoided due to their significant hepatotoxic potential. Tramadol is not recommended for cirrhosis due to its unpredictable effects. Codeine should also be avoided. Proper management includes the selection of drugs based on factors such as the type and severity of pain, duration of treatment, patient sensitivity, drug interactions, stage of liver disease, and the presence of other conditions. Patients should be closely monitored for adverse effects.
对慢性肝病（CLD）患者进行安全有效的疼痛治疗在临床实践中常常是一项挑战。止痛药的广泛使用可能导致药物性肝损伤。CLD可通过影响药物代谢酶和半衰期来改变药物反应，从而影响用药的强度和安全性。本研究综述了CLD中某些镇痛药的安全性和肝毒性。对乙酰氨基酚在使用标准剂量时是最安全的药物。安乃近短期治疗无禁忌。非甾体抗炎药因其显著的肝毒性潜力应避免使用。曲马多因其效果不可预测，不推荐用于肝硬化患者。也应避免使用可待因。合理的管理包括根据疼痛类型和严重程度、治疗持续时间、患者敏感性、药物相互作用、肝病阶段以及其他疾病的存在等因素选择药物。应密切监测患者的不良反应。
