Nonsteroidal antiinflammatory drugs and leukotriene receptor antagonists

Nonsteroidal antiinflammatory drugs (NSAIDs) are among the most commonly implicated agents for nonacetaminophen-related hepatotoxicity. Disease-modifying antirheumatic drugs and leukotriene receptor antagonists are less likely to cause drug-induced liver injury (DILI). With the appearance of several large international DILI registries, the incidence of NSAID-related liver injury can be more precisely determined. This chapter presents an update on the clinical presentation and pathological spectrum of hepatotoxicity with these classes of agents, including reports of patients who progressed to acute liver failure. Diclofenac and sulindac remain the most commonly reported NSAIDs associated with acute DILI in the United States, while nimesulide, a COX-2 inhibitor still available in some countries, holds the distinction of having caused the most acute liver failure.