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Topical Diclofenac-Induced Hepatotoxicity.

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Topical diclofenac gel, though generally safe, can cause liver injury in some patients. This case highlights the need for monitoring liver function, even with topical non-steroidal anti-inflammatory drugs.

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Area of Science:

  • Hepatology
  • Clinical Pharmacology
  • Pharmacovigilance

Background:

  • Diclofenac is a widely used non-steroidal anti-inflammatory drug (NSAID).
  • Hepatotoxicity is a known risk associated with oral diclofenac formulations.
  • Cases of liver injury from topical diclofenac are rare but possible.

Observation:

  • An elderly patient with Paget's disease and osteoarthritis developed acute liver injury.
  • The liver injury occurred four months after initiating and increasing the dose of topical diclofenac 1% gel.
  • Liver function tests returned to normal three weeks after discontinuing the topical diclofenac gel.

Findings:

  • A causality assessment tool indicated a possible link between topical diclofenac use and the observed hepatotoxicity.
  • The temporal association between diclofenac gel use and abnormal liver function tests supports the diagnosis of drug-induced liver injury.
  • This case suggests that topical NSAIDs, including diclofenac, may pose a risk of hepatotoxicity.

Implications:

  • Further research is needed to understand the risks of topical NSAIDs.
  • Establishing monitoring guidelines for patients using topical diclofenac is crucial.
  • Early detection and avoidance of adverse effects from topical diclofenac are important for patient safety.