Systematic review: ibuprofen-induced liver injury

Area of Science:

• Hepatology
• Pharmacology
• Toxicology

Background:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) are a significant cause of drug-induced liver injury (DILI).
• Ibuprofen, a widely used NSAID, has documented cases of hepatotoxicity.
• Understanding ibuprofen-induced liver injury is crucial for patient safety.

Purpose of the Study:

• To characterize the phenotypic expression of ibuprofen-induced liver injury.
• To analyze existing literature on ibuprofen hepatotoxicity.
• To provide a comprehensive overview of ibuprofen-induced DILI.

Main Methods:

• Systematic literature search for case series and case reports on ibuprofen-induced liver injury.
• Analysis of demographic, clinical, biochemical, and outcome data.
• Identification and review of idiosyncratic ibuprofen hepatotoxicity cases.

Main Results:

• Twenty-two cases of idiosyncratic ibuprofen hepatotoxicity were identified, indicating a low prevalence.
• Hepatocellular injury was the predominant pattern, with a mean age of 31 years and 55% female patients.
• Six cases developed vanishing bile duct syndrome; 11 patients recovered fully, while five experienced liver failure requiring transplantation or resulting in death.

Conclusions:

• Ibuprofen-associated DILI typically presents as hepatocellular damage with a short onset.
• Physicians should consider ibuprofen hepatotoxicity in differential diagnoses.
• Despite potential severe outcomes, ibuprofen is generally considered safe and effective due to its low absolute risk of liver complications.