There is a clear reduced dose for paracetamol for stable cirrhotic, but for acute compromisation of liver function such severe acute hepatitis or post agressive liver resection no clear data about a safe adjusted antipyretic drug use according to liver function. Can monitoring paracetamol level prevent its hepatotoxicity in such citation?
Burns et al recommended that for patients with chronic active alcohol ingestion and cirrhosis, acetaminophen may be used at a maximum of 2 grams per day, which is one-half the recommended daily dose (well below toxicity levels).
Burns MJ. Acetaminophen (paracetamol) poisoning in adults: pathophysiology, presentation, and diagnosis. UpToDate. http://www.uptodate.com/contents/acetaminophen-paracetamol-poisoning-in-adults-pathophysiology-presentation-and-diagnosis. Accessed September 12, 2013.
In this case i think that aspirin or another nonsteroidal anti-inflammatory drug can be used. Even with a low doses of acetaminophen toxicity is possible if the rate of cytochrome P450 is high
I agree with Mohamed A. Hammad . But what hepatitis etiologies? If it's an alcoholic hepatitis with a fever, can consider of prednison use? Your question only about paracetamol use?
Sincerely, Zmicer
in Spain we also use magnesium dipyrone (metamizol) or ibuprofen.
We use Paracetamol in usual dosage for children with hepatitis or cirrhosis, unless there are specific contraindications. Aspirin is never used in this population.
High fever is distinctly rare among hepatitis.
First, consider angiocholitis, then drug-induced hepatitis, the alcoholic.
Finally, is fever's treatment necessary in addition to cause's treatment?
Febrile patients with acute hepatitis can take different types of antipyretic without problems. However, you should avoid cortisone in case of acute viral hepatitis, and paracetamol in case of signs of hepatic insufficiency. Finally, in presence of alterations of coagulation cascade I would avoid NSAIDs.
For patients with high liver enzymes, paracetamol should NOT be used. It is dangerous. Hepaticenzyme before tablet PCM and 3 hours after, will be elevated.
I use mefenemic acid if platlets are above 100,000/cmm. I tell them to use if only fever > 101°F, or
Tapid sponging.
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