Systematic review: ibuprofen‐induced liver injury

Summary Background Nonsteroidal anti‐inflammatory drugs (NSAIDs) are a leading cause of drug‐induced liver injury (DILI) across the world. Ibuprofen is one of the most commonly used and safest NSAIDs, nevertheless reports on ibuprofen‐induced hepatotoxicity are available. Aim To analyse previously published information on ibuprofen‐induced liver injury for a better characterisation of its phenotypic expression. Method A systematic search was performed and information on ibuprofen‐induced liver injury included in case series and case reports, in terms of demographic, clinical, biochemical and outcome data, was analysed. Results Twenty‐two idiosyncratic ibuprofen hepatotoxicity cases were identified in the literature, suggesting a very low prevalence of this type of DILI. These patients had a mean age of 31 years and 55% were females. Mean cumulative dose of ibuprofen and time to onset were 30 g and 12 days, respectively. Hepatocellular injury was the most frequently involved liver injury pattern. Six cases developed vanishing bile duct syndrome. Full recovery occurred in 11 patients after a mean time of 14 weeks, whereas five cases evolved to acute liver failure leading to death/liver transplantation. Conclusions When assessing potential hepatotoxicity cases, physicians should keep in mind that ibuprofen has been associated with hepatotoxicity in the literature. Ibuprofen‐associated DILI presents commonly as hepatocellular damage after a short latency period. Published reports on ibuprofen hepatotoxicity leading to liver failure resulting in liver transplantation or death are available. However, due to the apparent low absolute risk of ibuprofen‐induced liver complications, ibuprofen can be regarded as an efficacious and safe NSAID.