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Forum Name: Liver Diseases

Question: Hep C, Liver failure and Painkillers


 Uforica - Sat Jul 17, 2010 1:10 pm

Hi, my partner has Hep C and has been given 6 months as her Liver is failing.
She has got severe tooth ache and can not see the dentist until mid-week, she does not want to go to the hospital as her Ascites makes moving anywhere a long and breathless experience. Are there any painkillers available over the counter that will not be detrimental to her condition. I have read all i can find but most say that painkillers should be avoided or taken in very small doses. She is allergic to Ibuprofen.
Thanks.
 Dr.M.Aroon kamath - Mon Jul 19, 2010 12:21 pm

User avatar Hi,

It would be highly improper for me to suggest anlgesia for your partner(or anyone else) in a forum such as this without first hand knowledge about her condition.

Your query: "Are there any painkillers available over the counter that will not be detrimental to her condition?".
There is no analgesic in modern medicine(to the best of my knowledge) that is not potentially detrimental to her condition.

To discuss in general terms, choosing an analgesic in chronic liver failure(especially in decompensated chronic liver failure) is a dicey proposition. The choices are very limited and fraught with uncertainty in any individual case. The pharmacokinetics and pharmacodynamics of an analgesic in any person with terminal liver failure can't be predicted. So, proper dosage is difficult to plan and adequate analgesia may or may not ensue.

Generally, Paracetamol is considered relatively safe even in in the conventional doses. Non steroidal anti-inflammatory drugs (NSAIDs) are contraindicated.

Opioids may be used, but may precipitate encephalopathy (this is less likely with dihydrocodeine than codeine phosphate).One should keep in mind the possibility of opioid accumulation even when administered at traditional doses.

You indicate that she has very severe tooth ache. If in case it is due to a pulp infection(pulp abscess), the pain is unlikely to be relieved with analgesics alone. Have a dental surgeon see her and decide on the management. Pain due to a pulp abscess, is almost certain to completely abate once the abscess is drained.This will obviate the need for analgesics.
Good luck!
 Uforica - Tue Jul 20, 2010 7:57 pm

Dr.M.Aroon kamath

Thank you for your time regarding this matter, my partner has taken your advice into account and is seeking an emergency appointment with her GP.
 Dr.M.Aroon kamath - Mon Jul 26, 2010 2:02 pm

User avatar Hi Uforica,
That is good news. I hope your partner's pain gets relieved soon. It is far safer to see the doctor and be prescribed analgesics especially under these circumstances. Good luck!

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