A patient with liver cirrhosis requires pain management. Which analgesic should be AVOIDED?

NSAIDs (including ibuprofen) are contraindicated in patients with liver cirrhosis. They inhibit cyclooxygenase enzymes, reducing prostaglandin synthesis, which leads to renal vasoconstriction, impaired renal function, GI bleeding risk, and worsening of ascites. Patients with cirrhosis already have impaired coagulation and portal hypertension, making GI bleeds especially dangerous. Acetaminophen, in contrast, can be used safely at reduced doses (maximum 2 g/day) in patients with compensated cirrhosis who do not consume alcohol — the concern about acetaminophen hepatotoxicity in cirrhosis is overstated for therapeutic doses.