Is Hepatitis a contraindication for Acetaminophen?

Hepatitis A, B, or C on its own is not automatically a contraindication to Acetaminophen under the “liver disease” category.

Drug labeling identifies acetaminophen as contraindicated in severe hepatic impairment or severe active liver disease, while milder hepatic impairment calls for caution rather than automatic avoidance (Food and Drug Administration, 2023). A hepatitis diagnosis alone does not necessarily indicate significant liver dysfunction.

In practice, patients with chronic hepatitis who do not have cirrhosis, liver failure, or active severe illness can generally receive acetaminophen within recommended dosing. Hepatotoxicity risk is primarily dose related, and the literature supports acetaminophen as an appropriate first line analgesic in stable liver disease, with lower maximum daily dosing often used in cirrhosis rather than complete avoidance (Ge & Runyon, 2016; Alchin et al., 2022; Hayward et al., 2016). As we are not providing routine daily administration, our standard dose is fine for these patients. 

Greater caution is warranted in patients with clear liver dysfunction such as cirrhosis, liver failure, jaundice, or significant alcohol use. Acute viral hepatitis with marked illness is also higher risk, with evidence showing worse outcomes, particularly when cofactors like alcohol use or fasting are present (Park et al., 2023; Lee et al., 2025; Fontana et al., 2023).

The distinction is between having hepatitis and having significant liver dysfunction. The former does not automatically preclude acetaminophen use. Evidence of severe or active liver failure should prompt avoidance, dose reduction, or medical consultation.

References

• Food and Drug Administration. (2023). Acetaminophen drug label.
• Ge, P. S., & Runyon, B. A. (2016). Treatment of patients with cirrhosis. New England Journal of Medicine.
• Alchin, J., Dhar, A., Siddiqui, K., & Christo, P. J. (2022). Why paracetamol (acetaminophen) is a suitable first choice for treating mild to moderate acute pain in adults with liver disease. Current Medical Research and Opinion.
• Hayward, K. L., Powell, E. E., Irvine, K. M., & Martin, J. H. (2016). Can paracetamol be administered to patients with liver impairment? British Journal of Clinical Pharmacology.
• Park, G. C., Chung, J. W., Jang, E. S., & Kim, J. W. (2023). Association between adverse outcomes of hepatitis A and acetaminophen use. Digestive and Liver Disease.
• Lee, W. M., Barnard, C., Rule, J. A., et al. (2025). Association of acetaminophen use with severity and outcomes in viral hepatitis associated acute liver failure. American Journal of Gastroenterology.
• Fontana, R. J., Liou, I., Reuben, A., et al. (2023). AASLD practice guidance on drug induced liver injury. Hepatology.