Serious liver disease a risk factor for acetaminophen-induced liver injury

In patients initiating acetaminophen for cancer-related pain, the risk of developing treatment-induced liver injury is heightened in the presence of serious liver disease, a study has found.

The study included 562 patients treated with acetaminophen ≥1,500 mg/d, among whom 287 used the drug for ≥4 weeks. Of these patients, 102 who had available liver function test data prior to and after acetaminophen treatment were included in the analysis. Drug-induced liver injury was evaluated by alanine aminotransferase (ALT) and alkaline phosphatase (APT) levels, Naranjo score, and Child-Pugh classification.

Following acetaminophen administration, 27 patients (26.5 percent) had an ALT or APT level elevated by at least 1 grade, with 20 of them having a Naranjo score ≥5, indicating a relationship between liver function test abnormalities and acetaminophen administration in 19.6 percent of patients. Overall, 20 had drug-induced liver injury.

On multivariate logistic regression analysis, drug-induced liver injury was associated with serious liver disease (odds ratio [OR], 12.41; p=0.049) and age ≥70 years (OR, 3.49; p=0.025).

The researchers stated that their study is the first to suggest the importance of assessing serious liver disease using Child-Pugh classification prior to the initiation of acetaminophen in patients with suspected liver disease.

“We believe that after assessment of the severity of liver disease, appropriate treatment with acetaminophen can eliminate the pain experienced during cancer and other diseases, while preventing serious complications, and improving quality of life,” they said.