The extended prescription of non-steroidal anti-inflammatory drugs in medical practice involve numerous adverse effects. Among them, hepatic
injuries, rather uncommon, are very diverse with regard to clinical type and evolution scheme, according to the derivatives used.
Salicylates, when taken at high doses, increase serum
transaminases, mostly without overt clinical symptoms.
Phenylbutazone is obviously hepatotoxic: it induces cytolytic
hepatitis, in some cases with fatal issue. Among the
indole derivatives, indometacine was involved, especially in children; mixed
hepatitis have been noted during
sulindac therapy, mostly with favourable outcome. In the group of
propionic acid derivatives,
ibuprofen,
pirprofen and
naproxen have been implicated in
hepatitis of various types;
ibufenac and
benoxaprofen were quickly retired after occasioning several deaths. Concerning others non-steroidal anti-inflammatory drugs, some cases have been reported with
piroxicam and
diclofenac. Hepatotoxicity mechanisms are often unknown; they appear different according to each
drug. Besides, the
rheumatic disease under treatment and pharmacokinetic particularities (
sulindac,
diclofenac) might be important in this view. Monitoring of serum hepatic-
enzyme concentrations seems recommended for patients receiving non-steroidal anti-inflammatory for long time
therapy.