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Nimesulide-induced hepatitis and acute liver failure
1Department of Gastroenterology, Sheba Medical Center, Tel-Hashomer, Israel.
The Israel Medical Association Journal : IMAJ
|March 25, 2000
Summary
Nimesulide, a selective COX-2 inhibitor, can cause liver injury ranging from mild enzyme elevations to fatal hepatic failure. Monitoring liver enzymes during nimesulide therapy is recommended to detect potential hepatotoxicity.
Area of Science:
- Hepatology
- Pharmacology
- Drug-induced liver injury
Background:
- Nimesulide is a selective cyclooxygenase 2 inhibitor NSAID.
- While often causing mild, reversible liver enzyme elevations, symptomatic hepatitis cases have been reported.
Observation:
- This study retrospectively analyzed six patients with elevated aminotransferase levels after nimesulide use for joint pain.
- Five patients were female, with a median age of 59.
- Follow-up included drug discontinuation and testing for viral and autoimmune hepatitis.
Findings:
- One patient remained asymptomatic; four developed symptoms like fatigue and nausea weeks after starting nimesulide.
- Hepatocellular injury showed median peak ALT 15x ULN, normalizing in 2-4 months.
- One patient progressed to acute hepatic failure, encephalopathy, and hepatorenal syndrome, resulting in death.
Implications:
- Nimesulide can induce a spectrum of liver damage, from asymptomatic enzyme changes to severe, fatal hepatitis.
- Close monitoring of liver enzymes is crucial for patients initiating nimesulide therapy.
- Early detection and intervention are vital for managing nimesulide-induced hepatotoxicity.