Drug Safety 2008; 31 (3): 261-270 ORIGINAL RESEARCH ARTICLE 0114-5916/08/0003-0261/$48.00/0 © 2008 Adis Data Information BV. All rights reserved. Use of Over-the-Counter Analgesics in Patients with Chronic Liver Disease Physicians’ Recommendations Simona Rossi, 1 David N. Assis, 1 Monica Awsare, 1 Mark Brunner, 2 Kevin Skole, 3 Jitha Rai, 4 Jocelyn Andrel, 1 Steven K. Herrine, 1 Rajender K. Reddy 4 and Victor J. Navarro 1 1 Thomas Jefferson University Hospital and Thomas Jefferson University, Philadelphia, Pennsylvania, USA 2 Geisinger Health System, Danville, Pennsylvania, USA 3 Temple University, Philadelphia, Pennsylvania, USA 4 University of Pennsylvania, Philadelphia, Pennsylvania, USA Background: Over-the-counter analgesics (OTCAs), principally paracetamol Abstract (acetaminophen)-containing compounds and NSAIDs, are commonly used medi- cations. Guidelines for the use of these agents in patients with chronic liver disease (CLD) are not available, despite the possibility that such patients may be more susceptible to the effects of an adverse reaction. Notwithstanding the lack of guidelines for healthcare providers, patients are often counselled to modify their use of these drugs. Therefore, the primary aim of this study was to assess healthcare providers’ recommendations on how OTCAs should be used by patients with CLD. Methods: An 11-question web-based survey was distributed via email to health- care providers participating in four healthcare networks in the US, to determine what recommendations they make to patients with cirrhosis (compensated and decompensated) and chronic hepatitis regarding the use of paracetamol and NSAIDs. Healthcare providers were also queried about the recommendations they make to patients with cirrhosis regarding pain control, and on the use of paraceta- mol for patients who consume alcohol daily. Results: Overall, a 12% response rate was obtained. Internal medicine, family practice, paediatrics, and gastroenterology were the most represented practice types. Recommendations against the use of NSAIDs were significantly less common than recommendations against paracetamol use, in cases of both com- pensated and decompensated cirrhosis (p = 0.001). Non-gastroenterologists and non-primary care physicians were the least likely to recommend against NSAID use (p = 0.001), while gastroenterologists were the least likely to recommend against paracetamol in these patients (p = 0.001). It was the recommendation of