[Hepatitis due to nonsteroidal anti-inflammatory agents]

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.