Can ibuprofen be used with abnormal Liver Function Tests (LFT)?

From the Guidelines

Ibuprofen should be used with caution in patients with abnormal Liver Function Tests (LFT), and its use should be carefully monitored due to the potential risk of worsening liver damage. When considering the use of ibuprofen in patients with abnormal LFT, it is essential to weigh the potential benefits against the risks, particularly in the context of liver disease, where medications like rifampicin can cause hyperbilirubinemia due to competition for hepatic excretion 1.

Key Considerations

• Ibuprofen is metabolized by the liver, and its use in patients with abnormal LFT may lead to increased liver damage or reduced drug clearance.
• Alternative pain management strategies, such as reduced doses of acetaminophen (Tylenol) under medical supervision, may be safer for patients with abnormal liver function.
• The British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD) recommend cautious use and monitoring of LFTs in patients with liver disease 1.

Clinical Implications

• Patients with abnormal LFT should consult with their healthcare provider to discuss appropriate pain management options tailored to their specific condition.
• Close monitoring of LFTs is crucial when using ibuprofen in patients with liver disease to minimize the risk of worsening liver damage.
• The potential for drug interactions, such as those seen with rifampicin, should be carefully considered when managing patients with abnormal LFT and liver disease 1.

From the FDA Drug Label

Hepatic effects Borderline elevations of one or more liver tests may occur in up to 15% of patients taking NSAIDs, including ibuprofen tablets These laboratory abnormalities may progress, may remain unchanged, or may be transient with continuing therapy. Notable elevations of ALT or AST (approximately three or more times the upper limit of normal) have been reported in approximately 1% of patients in clinical trials with NSAIDs In addition, rare cases of severe hepatic reactions, including jaundice, fulminant hepatitis, liver necrosis, and hepatic failure, some of them with fatal outcomes have been reported A patient with symptoms and/or signs suggesting liver dysfunction, or with abnormal liver test values, should be evaluated for evidence of the development of a more severe hepatic reaction while on therapy with ibuprofen tablets. If clinical signs and symptoms consistent with liver disease develop, or if systemic manifestations occur (e.g., eosinophilia, rash, etc.), ibuprofen tablets should be discontinued.

Ibuprofen should be used with caution in patients with abnormal Liver Function Tests (LFT).

• Patients with abnormal LFTs should be evaluated for evidence of a more severe hepatic reaction while on therapy with ibuprofen.
• If clinical signs and symptoms consistent with liver disease develop, ibuprofen should be discontinued 2.
• It is recommended to monitor patients with abnormal LFTs for signs or symptoms of liver disease and discontinue ibuprofen if necessary 2.

From the Research

Ibuprofen and Abnormal Liver Function Tests (LFTs)

• There is evidence to suggest that ibuprofen can be associated with hepatotoxicity, although the risk is considered low 3.
• A systematic review of ibuprofen-induced liver injury found 22 cases of idiosyncratic hepatotoxicity, with a mean age of 31 years and 55% of cases being female 3.
• The most common liver injury pattern was hepatocellular injury, and six cases developed vanishing bile duct syndrome 3.
• A case report described a 65-year-old man who developed liver failure after taking an ibuprofen-sustained release capsule, highlighting the importance of monitoring liver function in patients taking ibuprofen 4.

Considerations for Prescribing Ibuprofen with Abnormal LFTs

• When prescribing medications to patients with abnormal LFTs, it is essential to establish the cause of the abnormal liver function and determine if the patient has cirrhosis 5.
• In advanced liver disease, drugs with predominant hepatic metabolism and/or excretion should be used with caution, particularly those with a narrow therapeutic index 5.
• Idiosyncratic drug reactions are equally common in patients with normal or abnormal liver function, and comprehensive diagnostic evaluation is essential to identify the underlying etiology of abnormal LFTs 6.

Safety of Ibuprofen in Patients with Liver Disease

• While acetaminophen is often recommended as a preferred analgesic/antipyretic in patients with liver disease due to its safety profile, ibuprofen can be considered a safe option in patients with abnormal LFTs, although with caution 7, 3.
• The risk of hepatotoxicity associated with ibuprofen is considered low, and the drug can be regarded as efficacious and safe in most cases 3.