Which of the following NSAIDs should be avoided in patients with underlying hepatic cirrhosis due to increased risk of liver toxicity?

A Celecoxib

B Ibuprofen

C Naproxen

D Diclofenac

Solution

Correct Answer: Option A

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for their analgesic and anti-inflammatory effects. However, their use in patients with underlying hepatic cirrhosis requires caution due to the risk of exacerbating liver injury and other complications.

Among the options given:

- Celecoxib is a selective COX-2 inhibitor that has been associated with increased risk of hepatotoxicity in certain patients. Although generally considered safer on the gastrointestinal tract compared to non-selective NSAIDs, celecoxib carries a higher propensity for liver enzyme elevations and rare cases of severe liver injury, especially in those with pre-existing liver impairment such as cirrhosis.

- Ibuprofen, Naproxen, and Diclofenac
are non-selective NSAIDs. While diclofenac also has some hepatotoxic potential, it is less consistently associated with severe liver injury in cirrhotic patients compared to celecoxib. Nonetheless, all NSAIDs should be used cautiously in cirrhosis due to risk of renal impairment and gastrointestinal bleeding, but the heightened liver toxicity specifically pertains more markedly to celecoxib.

In patients with hepatic cirrhosis, any NSAID use should be closely monitored or avoided if possible, but celecoxib is particularly contraindicated due to its higher risk of liver toxicity.

Key points to remember:
- Cirrhosis impairs liver function and drug metabolism, increasing risk of toxicity.
- Celecoxib has a stronger association with hepatotoxicity than other common NSAIDs.
- Ibuprofen, naproxen, and diclofenac must be used cautiously but are not as hepatotoxic as celecoxib in cirrhotic patients.
- Avoid NSAIDs when possible; consider alternative analgesics in cirrhosis.

Reference: Goodman & Gilman's The Pharmacological Basis of Therapeutics, 13th Edition, Chapter 19: Nonsteroidal Anti-Inflammatory Drugs & Related Agents / Page 459-462

Practice More Questions on Our App!

Download our app for free and access thousands of MCQ questions with detailed solutions