Speeds Hepatitis C Into Cirrhosis Of The Liver
Patients with chronic hepatitis C often take the
over-the-counter non-steroidal drug Ibuprofen
(otherwise known as Motrin or Advil) to combat the
joint pain that often accompanies the disease. But
even a low dose could lead to unsuspected liver
"Patients frequently suffer from joint pain.
Often, even physicians will prescribe ibuprofen when
they should prescribe Tylenol," explains Thomas
Riley, III, M.D., assistant professor of medicine at
Penn State's College of Medicine. "The correct
recommendation to help the patient is a low dose of
Tylenol, about 2 grams per day. That means the patient
can take one extra strength Tylenol -- 500 mg -- every
six hours or take two every 12 hours."
Riley and his colleagues describe three cases in an
article, "Ibuprofen Induced Hepatoxicity in Those
With Chronic Hepatitis C: A Case Series," in the
September issue of the American Journal of
In each of these three cases, the patients have
hepatitis C and took over-the-counter ibuprofen. After
doing so they all had a flare-up of their hepatitis.
"Many physicians don't want to prescribe
Tylenol because it has a reputation of causing liver
damage. As long as it is prescribed in the low doses
we have discussed it is definitely the best
treatment," explains Riley, who is also the
medical director for the liver transplant program at
The Milton S. Hershey Medical Center of the Penn State
Geisinger Health System.
Riley also says that while patients with chronic
hepatitis C usually have mild elevations in liver
enzymes in their blood, after taking the
over-the-counter Ibuprofen they experience a ten-fold
rise in their enzymes, suggesting significant liver
He adds that if too much medication is taken, the
patient risks speeding up the process of going from
chronic hepatitis to cirrhosis of the liver.
Riley says that about four million Americans are
infected with hepatitis C. Some of the more common
ways it is contracted are by IV drug use, a blood
transfusion, or getting a tattoo.
"Many patients can live with hepatitis for
perhaps 50 years. However, if too much of the wrong
medication is taken or if the patient consumes a lot
of alcohol, the process from hepatitis to cirrhosis
can speed up," says Riley.
This article focuses on three cases. Riley says
further study is needed of a large group of patients
with hepatitis C to determine perhaps an even better
approach to this growing problem.