Acute Liver Failure Due to Etodolac, a Selective Cycloxygenase- 2 (COX -2) Inhibitor Non-Steroidal Anti-Inflammatory Drug Established by RUCAM-Based Causality Assessment

Ann Hepatol. 2017 Sep-Oct;16(5):818-821. doi: 10.5604/01.3001.0010.2829.

Abstract

Drug induced liver injury is a common cause of acute liver failure (ALF). While most of these cases are due to dose dependent hepatotoxicity with acetaminophen, idiosyncratic drug-induced liver injury (DILI) is responsible for about 15% cases of ALF. Antibiotics are the most common cause of idiosyncratic DILI as well as DILI induced ALF. Etodolac is a selective cycloxygenase- 2 (COX -2) inhibitor non-steroidal anti-inflammatory drug used as an analgesic and anti-inflammatory in musculoskeletal diseases. Severe liver impairment is extremely rare. Till date, only 3 cases of ALF related to etodolac have been reported in the literature. Here we report two cases with a unique presentation of ALF occurring due to DILI caused by etodolac, as diagnosed by Roussel Uclaf Causality Assessment Method (RUCAM).

Keywords: Drug induced liver injury; Hepatic encephalopathy.; Hepatotoxin; Liver failure; Liver transplantation.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged, 80 and over
  • Chemical and Drug Induced Liver Injury / diagnosis
  • Chemical and Drug Induced Liver Injury / etiology*
  • Chemical and Drug Induced Liver Injury / therapy
  • Cyclooxygenase 2 Inhibitors / adverse effects*
  • Disease Progression
  • Etodolac / adverse effects*
  • Fatal Outcome
  • Female
  • Hepatic Encephalopathy / chemically induced
  • Humans
  • Liver Failure, Acute / chemically induced*
  • Liver Failure, Acute / diagnosis
  • Liver Failure, Acute / therapy
  • Liver Function Tests
  • Risk Factors

Substances

  • Cyclooxygenase 2 Inhibitors
  • Etodolac