Opioids linked with hepatic encephalopathy in patients with cirrhosis
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Opioid prescriptions were associated with a risk for hepatic encephalopathy in patients with compensated cirrhosis, according to study results.
Andrew M. Moon, MD, MPH, of the division of gastroenterology and hepatology at the University of North Carolina at Chapel Hill, and colleagues wrote that opioids could potentially contribute to risk for HE in these patients, but current research has returned conflicting results.
“Opioids could lead to altered gut microbiota, upregulation in central mu-opioid receptors and slowed intestinal motility, which could increase intestinal absorption of ammonia and inflammatory mediators,” they wrote. “Despite their potential harms, opioid use is frequent and increasing over time in patients with cirrhosis, possibly due to the avoidance of nonsteroidal anti-inflammatory drugs and acetaminophen in these patients. In an era of increasing opioid use, the relative risk of HE among patients taking opioids remains unclear.”
Researchers identified patients aged 18 to 64 years with cirrhosis using data from the IQVIA database and grouped them based on opioid use in the 6 months after cirrhosis diagnosis (n = 1,806). They categorized patients who used opioids for between 1 and 89 days as short-term (n = 1,505) and between 90 and 180 days as chronic (n = 301), and assessed how many patients developed HE over the subsequent year.
During follow-up, HE developed in 6.3% of patients with chronic opioid prescriptions, 5% with short-term prescriptions and 3.3% of patients who did not receive opioids.
Both short (HR = 1.44; 95% CI, 1.07–1.94) and chronic opioid prescriptions (HR = 1.83; 95% CI, 1.07–3.12) were associated with an increased risk for HE.
Moon and colleagues wrote that because of the link between opioids and HE, physicians should look for other non-opioid and non-pharmacologic options for pain control in patients with cirrhosis.
“In light of this potential harm of opioid prescriptions, these medications should be avoided when possible even in patients with well-compensated cirrhosis,” they wrote. “When opioid use is required, it should be short duration and clinicians should maintain a high vigilance for detecting HE.” – by Alex Young
Disclosure: Moon reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.
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