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Meperidine elimination is prolonged in the liver in patients with advanced liver disease and so should not be used, but fentanyl elimination is not appreciatively altered in patients with cirrhosis, and thus is a good option, as a sedative or in pain management, as long as it is used with caution.113 In the past, methadone was an attractive analgesic for patients with liver disease, but today it has been shown to have a long half-life and to accumulate in cirrhotic patients, and so its use is not recommended.115 The use of proton pump inhibitors (PPIs) in patients with cirrhosis has been associated with dysbiosis, in small intestinal bacterial overgrowth, C
Volinia, S
