ArticleAlimentary pharmacology & therapeutics2020
Opioid prescriptions are associated with hepatic encephalopathy in a national cohort of patients with compensated cirrhosis.
Article in Alimentary pharmacology & therapeutics, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
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Who cites it
20 citing papers in PubMed, 46 citations in OpenAlex.
- Navigating Chronic Pain in Patients with Cirrhosis: Unique Analgesic Considerations and Non-Pharmacologic Options.Current hepatology reports · 2026Review
- Opioid use after adult liver transplantation: Incidence, high-risk use, and adverse events in a large US cohort.Hepatology communications · 2025Article
- Hepatic Encephalopathy: Current Thoughts on Pathophysiology and Management.Current neurology and neuroscience reports · 2025Review
- Medication burden and anticholinergic use are associated with overt HE in individuals with cirrhosis.Hepatology communications · 2024Article
- The State of Use and Utility of Negative Controls in Pharmacoepidemiologic Studies.American journal of epidemiology · 2024Review
- Association of Renin-Angiotensin System Inhibition With Liver-Related Events and Mortality in Compensated Cirrhosis.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2024Article
- Pharmacological considerations in pharmacotherapy of rheumatology patients with liver disease: a brief narrative review.Reumatologia · 2024Review
- Changing Prevalence of Medication Use in People with Cirrhosis: A Retrospective Cohort Study Using Pharmaceutical Benefits Scheme Data.Drugs - real world outcomes · 2023Article
- Using Intervention Mapping to Develop a Novel Pain Self-Management Intervention for People with Cirrhosis.Digestive diseases and sciences · 2022Article
- Metamizole-Associated Risks in Decompensated Hepatic Cirrhosis.Deutsches Arzteblatt international · 2022Article
- AASLD Practice Guidance: Palliative care and symptom-based management in decompensated cirrhosis.Hepatology (Baltimore, Md.) · 2022Article
- Changing Epidemiology of Cirrhosis and Hepatic Encephalopathy.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2022Review
- Assessment of Alcohol and Other Substance Use in Patients With Chronic Liver Disease.Clinical liver disease · 2022Review
- Short-Term Safety of Repeated Acetaminophen Use in Patients With Compensated Cirrhosis.Hepatology communications · 2022Article
- Hospice care for end stage liver disease in the United States.Expert review of gastroenterology & hepatology · 2021Review
- Medication Treatment of Active Opioid Use Disorder in Veterans With Cirrhosis.The American journal of gastroenterology · 2021Article
- Opioid Use Is More Common in Nonalcoholic Fatty Liver Disease Patients with Cirrhosis, Higher BMI, and Psychiatric Disease.Digestive diseases (Basel, Switzerland) · 2021Observational
- Characteristics of opioid prescribing to outpatients with chronic liver diseases: A call for action.PloS one · 2021Article
- In inpatients with cirrhosis opioid use is common and associated with length of stay and persistent use post-discharge.PloS one · 2020Article
- Integrated Care of Alcohol-Related Liver Disease.Journal of clinical and experimental hepatologyArticle
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundOpioids are often prescribed for pain in cirrhosis and may increase the risk of hepatic encephalopathy (HE).
aimTo assess the association between opioids and HE in patients with well-compensated cirrhosis.
methodsWe used the IQVIA PharMetrics (Durham, NC) database to identify patients aged 18-64 years with cirrhosis. We excluded patients with any decompensation event from 1 year before cirrhosis diagnosis to 6 months after cirrhosis diagnosis. Over the 6 months after cirrhosis diagnosis, we determined the duration of continuous opioid use and classified use into short term (1-89 days) and chronic (90-180 days). We assessed whether patients developed HE over the subsequent year (ie 6-18 months after cirrhosis diagnosis). We used a landmark analysis and performed multivariable Cox proportional hazards regression to assess associations between opioid use and HE, adjusting for relevant confounders.
resultsThe cohort included 6451 patients with compensated cirrhosis, of whom 23.3% and 4.7% had short-term and chronic opioid prescriptions respectively. Over the subsequent year, HE occurred in 6.3% patients with chronic opioid prescriptions, 5.0% with short-term opioid prescriptions and 3.3% with no opioid prescriptions. In the multivariable model, an increased risk of HE was observed with short-term (adjusted hazard ratio, HR 1.44, 95% CI 1.07-1.94) and chronic opioid prescriptions (adjusted HR 1.83, 95% CI 1.07-3.12) compared to no opioid prescriptions.
conclusionIn this national cohort of privately insured patients with cirrhosis, opioid prescriptions were associated with the risk of incident HE. Opioid use should be minimised in those with cirrhosis and, when required, limited to short duration.
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