Can you take Aleve (naproxen) if you have cirrhosis of the liver?

Naproxen (Aleve) Should Not Be Used in Patients with Cirrhosis of the Liver

Non-steroidal anti-inflammatory drugs (NSAIDs) like Aleve (naproxen) should not be used in patients with cirrhosis of the liver due to high risk of developing further sodium retention, hyponatremia, and acute kidney injury. 1

Risks of NSAIDs in Cirrhosis

NSAIDs pose several significant risks in patients with cirrhosis:

• Renal impairment: NSAIDs inhibit renal prostaglandin synthesis, which can lead to acute kidney injury and hepatorenal syndrome 1, 2
• Sodium and fluid retention: Can worsen or precipitate ascites 1
• Diuretic resistance: May reduce effectiveness of diuretic therapy 1
• Gastrointestinal bleeding: Increased risk in patients with cirrhosis who may already have portal hypertension and varices 1, 2
• Hyponatremia: Can exacerbate existing electrolyte imbalances 1

Safe Alternatives for Pain Management in Cirrhosis

First-Line Option:

• Acetaminophen (Tylenol): Safe in patients with cirrhosis but should be used at reduced doses
  • Maximum daily dose: 2-3 grams per day (reduced from standard 4 grams)
  • Administer in divided doses (e.g., 650 mg twice daily) 3, 4

For Moderate to Severe Pain:

When acetaminophen is insufficient, consider:

• Preferred opioids (with careful monitoring):

  • Fentanyl
  • Buprenorphine
  • Hydromorphone
  • Methadone (may be safer due to pharmacokinetics less affected by hepatic impairment) 3

• Tramadol (with caution):

  • Limited to 50 mg every 12 hours (maximum 200 mg/day)
  • Avoid concomitant use with MAOIs, SSRIs, or other serotonergic medications 3

Important Precautions with Opioid Use:

• Co-prescribe laxatives to prevent constipation and hepatic encephalopathy 3, 2
• Use immediate-release formulations rather than controlled-release 2
• Monitor for signs of opioid toxicity (respiratory depression, sedation, confusion) 3
• Start with low doses and titrate slowly 2

Monitoring Recommendations

If pain medication is needed for patients with cirrhosis:

• Regular monitoring of liver function tests
• Regular monitoring of renal function (BUN, creatinine)
• Blood pressure monitoring
• Assessment for signs of hepatic encephalopathy
• Monitoring for GI bleeding 3

Conclusion

Naproxen (Aleve) and other NSAIDs should be avoided in patients with cirrhosis. Acetaminophen at reduced doses is the safest first-line analgesic option, with carefully monitored opioids as a second-line approach for more severe pain. Always prioritize medications with the lowest risk of precipitating complications of cirrhosis, particularly renal impairment, gastrointestinal bleeding, and hepatic encephalopathy.