Liver disorders NSAIDs

In certain liver disorders NSAIDs may actually be of benefit. For example, in biliary colic there is no impairment of liver synthetic function and thus NSAIDs may be safe to use. Prostaglandins are thought to increase pressure, secretions and contractions of the gallbladder, and thus there is a theoretical basis for pain improvement with NSAIDs. Studies with diclofenac have also demonstrated a reduced occurrence of cholecystitis, a frequent complication of biliary colic [2, 4, 44]. 

Potential benefits of NSAIDs in some liver disorders... 

Many centres prefer to avoid using NSAIDs in any patient with liver disease because of their side-effect profile. However, if the liver disorder is purely cholestatic in origin and the disease has not progressed to cirrhosis and portal hypertension, NSAIDs may be an option. Any risk-benefit assessment should consider the potential risk of hepatotox-icity, albeit rare. There are no specific contraindications in this patient because they are not cirrhotic, do not have deranged clotting, and are unlikely to be at increased risk of deteriorating renal function. If deemed necessary an NSAID could be used cautiously. 

Nabumetone is a naproxen derivative, whose efficacy is related to its active metabolite, 6-methoxy-2-naphthyla-cetic acid. Not unexpectedly, a study in 2000 patients, mostly treated for more than 6 months, ehcited an adverse events pattern similar to the other derivatives of this class of NSAIDs (SEDA-13, 81). Adverse effects were reported in 18% of patients and 10% stopped taking the drug because of adverse reactions. Diarrhea was the most common problem (13%) followed by abdominal pain (9.9%), dyspepsia (9.3%), nausea (7.8%), and flatulence (4.7%). Ten ulcers were detected. Nervous system reactions, skin rashes, edema, unspecified eye disorders, and liver function test abnormahties aU occur (1). 

Do not give if there is a history of active peptic ulcer, other GI ulceration, chronic inflammation of the GI tract, GI bleeding disorders, or a history of hypersensitivity to aspirin and other NSAIDs. Use caution with patients who have kidney, liver, GI tract disease, or a history of fluid retention. 

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