Hepatotoxicity of Mild Analgesics

Overview

Journal Br J Clin Pharmacol

Specialty Pharmacology

Date 1980 Oct 1

PMID 7002191

Citations 15

Authors

L F Prescott

Affiliations

Soon will be listed here.

Abstract

1 Hepatotoxicity is rare when mild analgesics are used in normal therapeutic doses. 2 The potential of aspirin and salicylates to cause hepatotoxicity has been only recently recognized. 3 Salicylate hepatitis is often asymptomatic, and may only be revealed by finding elevated levels of aminotransferases. 4 Most cases have occurred in children or young adults with connective tissue diseases, who take high doses of salicylates for long periods. 5 Hepatic injury is not recognized as a complication of acute aspirin poisoning. 6 Following overdosage of paracetamol, a toxic intermediate metabolite causes acute hepatic necrosis which may be fatal. 7 Cysteamine, methionine and N-acetylcysteine confer protection against this severe liver damage, but the time between overdosage and treatment is critical. 8 The chronic therapeutic use of paracetamol should be considered a potential but very rare cause of active chronic hepatitis. 9 There is no clear evidence of phenacetin hepatotoxicity in man. 10 Phenylbutazone may cause liver injury and other analgesics can cause hypersensitivity reactions in which the liver is involved.

Citing Articles

Paracetamol use and lowered risk of acute kidney injury in patients with rhabdomyolysis.

Desgrouas M, Boulain T J Nephrol. 2021; 34(5):1725-1735.

PMID: 33400139 DOI: 10.1007/s40620-020-00950-7.

PYP1-4 peptide from protects against acetaminophen-induced hepatotoxicity in HepG2 cells.

Kim I, Choi J, Nam T Exp Ther Med. 2020; 19(2):849-860.

PMID: 32010245 PMC: 6966212. DOI: 10.3892/etm.2019.8304.

Mechanistic identification of biofluid metabolite changes as markers of acetaminophen-induced liver toxicity in rats.

Pannala V, Vinnakota K, Rawls K, Estes S, OBrien T, Printz R Toxicol Appl Pharmacol. 2019; 372:19-32.

PMID: 30974156 PMC: 6599641. DOI: 10.1016/j.taap.2019.04.001.

Comparative Protective Effects of N-Acetylcysteine, N-Acetyl Methionine, and N-Acetyl Glucosamine against Paracetamol and Phenacetin Therapeutic Doses-Induced Hepatotoxicity in Rats.

Saleem T, El-Maali N, Hassan M, Mohamed N, Mostafa N, Abdel-Kahaar E Int J Hepatol. 2018; 2018:7603437.

PMID: 30245889 PMC: 6139237. DOI: 10.1155/2018/7603437.

Silymarin prevents acetaminophen-induced hepatotoxicity in mice.

Papackova Z, Heczkova M, Dankova H, Sticova E, Lodererova A, Bartonova L PLoS One. 2018; 13(1):e0191353.

PMID: 29342206 PMC: 5771617. DOI: 10.1371/journal.pone.0191353.

References

Schaller J . Chronic salicylate administration in juvenile rheumatoid arthritis: aspirin "hepatitis" and its clinical significance. Pediatrics. 1978; 62(5 Pt 2 Suppl):916-25. View

Prescott L, Sutherland G, Park J, Smith I, Proudfoot A . Cysteamine, methionine, and penicillamine in the treatment of paracetamol poisoning. Lancet. 1976; 2(7977):109-13. DOI: 10.1016/s0140-6736(76)92842-7. View

Bonkowsky H, MUDGE G, McMurtry R . Chronic hepatic inflammation and fibrosis due to low doses of paracetamol. Lancet. 1978; 1(8072):1016-8. DOI: 10.1016/s0140-6736(78)90740-7. View

Portmann B, Talbot I, Day D, Davidson A, Murray-Lyon I, Williams R . Histopathological changes in the liver following a paracetamol overdose: correlation with clinical and biochemical parameters. J Pathol. 1975; 117(3):169-81. DOI: 10.1002/path.1711170307. View

JUUL J . ACUTE POISONING WITH BUTAZOLIDIN (R) (PHENYLBUTAZONE). Acta Paediatr Scand. 1965; 54:503-7. DOI: 10.1111/j.1651-2227.1965.tb06407.x. View

Ulshen M, Grand R, Crain J, Gelfand E . Hepatoxicity with encephalopathy associated with aspirin therapy in rheumatoid arthritis. J Pediatr. 1978; 93(6):1034-7. DOI: 10.1016/s0022-3476(78)81252-9. View

Sillanpaa M, Makela A, Koivikko A . Acute liver failure and encephalopathy (Reye's syndrome?) during salicylate therapy. Acta Paediatr Scand. 1975; 64(6):877-80. DOI: 10.1111/j.1651-2227.1975.tb03941.x. View

JOLLOW D, Mitchell J, Potter W, Davis D, GILLETTE J, Brodie B . Acetaminophen-induced hepatic necrosis. II. Role of covalent binding in vivo. J Pharmacol Exp Ther. 1973; 187(1):195-202. View

Mitchell J, JOLLOW D, Potter W, Davis D, GILLETTE J, Brodie B . Acetaminophen-induced hepatic necrosis. I. Role of drug metabolism. J Pharmacol Exp Ther. 1973; 187(1):185-94. View

10.

Davidson D, Eastham W . Acute liver necrosis following overdose of paracetamol. Br Med J. 1966; 2(5512):497-9. PMC: 1943529. DOI: 10.1136/bmj.2.5512.497. View

11.

Johnson G, Tolman K . Chronic liver disease and acetaminophen. Ann Intern Med. 1977; 87(3):302-4. DOI: 10.7326/0003-4819-87-3-302. View

12.

Prescott L . The third Lilly Prize Lecture. University of London, January, 1979. The nephrotoxicity and hepatotoxicity of antipyretic analgesics. Br J Clin Pharmacol. 1979; 7(5):453-62. PMC: 1429589. DOI: 10.1111/j.1365-2125.1979.tb00986.x. View

13.

Athreya B, Moser G, CECIL H, Myers A . Aspirin-induced hepatotoxicity in juvenile rheumatoid arthritis. A prospective study. Arthritis Rheum. 1975; 18(4):347-52. DOI: 10.1002/art.1780180409. View

14.

Crome P, Vale J, Volans G, Widdop B, Goulding R . Oral methionine in the treatment of severe paracetamol (Acetaminophen) overdose. Lancet. 1976; 2(7990):829-30. DOI: 10.1016/s0140-6736(76)91211-3. View

15.

Rich R, Johnson J . Salicylate hepatotoxicity in patients with juvenile rheumatoid arthritis. Arthritis Rheum. 1973; 16(1):1-9. DOI: 10.1002/art.1780160102. View

16.

Rosenberg D, Meyer A, MANNING Jr I, Neelon F . Acetaminophen and hepatic dysfunction in infectious mononucleosis. South Med J. 1977; 70(6):660-1. DOI: 10.1097/00007611-197706000-00007. View

17.

Barker Jr J, de Carle D, Anuras S . Chronic excessive acetaminophen use and liver damage. Ann Intern Med. 1977; 87(3):299-301. DOI: 10.7326/0003-4819-87-3-299. View

18.

Lesna M, Watson A, Douglas A, Hamlyn A, James O . Evaluation of paracetamol-induced damage in liver biopsies. Acute changes and follow-up findings. Virchows Arch A Pathol Anat Histol. 1976; 370(4):333-44. DOI: 10.1007/BF00445778. View

19.

Petty B, Zahka K, Bernstein M . Aspirin hepatitis associated with encephalopathy. J Pediatr. 1978; 93(5):881-2. DOI: 10.1016/s0022-3476(78)81109-3. View

20.

MUSCAT-BARON J, Freeman D . Toxic hepatitis following phenylbutazone therapy. Br J Clin Pract. 1966; 20(8):437-9. View