Does Opioid Use Increase the Risk of Hepatic Encephalopathy in Cirrhosis?

Short‐term and chronic opioid prescriptions are associated with an increased risk of hepatic encephalopathy (HE) among patients with well-compensated cirrhosis, according to findings of a new study.

To reach this conclusion, the researchers identified 6451 patients aged 18 to 64 years with compensated cirrhosis from the IQVIA PharMetrics database. The patients had not experienced any decompensation event from 1 year before having received a cirrhosis diagnosis to 6 months after having received a cirrhosis diagnosis.


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Based on the participants’ duration of continuous opioid use over the 6 months after having received a cirrhosis diagnosis, 23.3% of patients were classified as having short-term opioid prescriptions (1-89 days) and 4.7% of patients were classified as having chronic opioid prescriptions (90-180 days).

Over a 1-year follow-up period, 250 patients developed HE. Of these, 6.3% had chronic opioid prescriptions, 5.0% had short‐term opioid prescriptions, and 3.3% had no opioid prescriptions.

In the multivariable model, an increased risk of HE was observed with short‐term and chronic opioid prescriptions compared with no opioid prescriptions.

“In this national cohort of privately insured patients with cirrhosis, opioid prescriptions were associated with the risk of incident HE,” the researchers concluded. “Opioid use should be minimized in those with cirrhosis and, when required, limited to short duration.”

—Colleen Murphy


Moon AM, Jiang Y, Rogal SS, Tapper EB, Lieber SR, Barritt IV AS. Opioid prescriptions are associated with hepatic encephalopathy in a national cohort of patients with compensated cirrhosis [published online January 21, 2020]. Aliment Pharmacol Ther. doi:10.1111/apt.15639.