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• Beware of liver disease for High dose ibuprofen in cystic fibrosis
  Maria Isabel Arranz
  Published on: 22 March 2016
• High dose ibuprofen in cystic fibrosis: Beware of liver disease
  Mordi R Muorah
  Published on: 22 March 2016

• Published on: 22 March 2016

  Beware of liver disease for High dose ibuprofen in cystic fibrosis

  • Maria Isabel Arranz
  • Other Contributors:
    • et al.

  Dear Editor

  We read also with interest the response to " High dose ibuprofen in cystic fibrosis"[1] as "Beware of liver disease" from Mordy R Muorah, and his question about if similar exclusion criteria than Konstan MW applied in his research,[2] we also did. Exclusion criteria were needed for oral steroids, or other NSAIDs, known as hypersensitivity to NSAIDs, liver disease, peptic ulcera, or cardiac, renal, hem...

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  Dear Editor

  We read also with interest the response to " High dose ibuprofen in cystic fibrosis"[1] as "Beware of liver disease" from Mordy R Muorah, and his question about if similar exclusion criteria than Konstan MW applied in his research,[2] we also did. Exclusion criteria were needed for oral steroids, or other NSAIDs, known as hypersensitivity to NSAIDs, liver disease, peptic ulcera, or cardiac, renal, hematologic or neurologic disease. Patients with a history of current or past mild abnormalities in the serum levels of liver enzymes but without other evidence of liver disease, were included. Thank you so much for your interest about our work.

  References

  (1) Arranz I. et al. Population pharmacokinetics of high dose ibuprofen in cystic fibrosis. Arch. Dis. Child. 88, 1128-1130 (2003).

  (2) Konstan MW, Byard PJ, Hoppel, CL and Davis PB. Effect of High-Dose Ibuprofen in Patients with Cystic Fibrosis. N Engl J Med 332, 848-854 (1995).

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  Conflict of Interest:
  None declared.

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• Published on: 22 March 2016

  High dose ibuprofen in cystic fibrosis: Beware of liver disease

  • Mordi R Muorah, Paediatric Hepatology SHO
  • Other Contributors:
    • Rupert Hinds and Nedim Hadzic

  Dear Editor

  We read with interest the study on the use of high dose ibuprofen in cystic fibrosis (CF) by Arranz et al.[1] Whilst we appreciate the possible beneficial effects of high dose ibuprofen on lung function, we are concerned that its non-critical use could be associated with some risks, despite monitoring of drug levels.

  The authors quote an earlier report showing that ibuprofen can be u...

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  Dear Editor

  We read with interest the study on the use of high dose ibuprofen in cystic fibrosis (CF) by Arranz et al.[1] Whilst we appreciate the possible beneficial effects of high dose ibuprofen on lung function, we are concerned that its non-critical use could be associated with some risks, despite monitoring of drug levels.

  The authors quote an earlier report showing that ibuprofen can be used in patients with CF to slow the deterioration in pulmonary function ‘without unacceptable side effects’.[2] It is, however, important to note that in the cited article the CF patients with liver disease, renal disease, hypersensitivity to non-steroidal anti-inflammatory drugs (NSAID), allergic broncho-pulmonary aspergillosis, colonized with Burkholderia cepacia, and cardiovascular, neurologic, haematologic, or peptic ulcer disease had been excluded and only those with mild respiratory involvement were studied.[2] It is unclear whether similar exclusion criteria were applied by Arranz et al.[1]

  Liver disease develops in approximately 25% of CF patients and represents their third most common cause of death.[3,4] The main hepatological complication of CF is biliary cirrhosis with development of portal hypertension and oesophageal varices.[3,4] Detection of liver disease in CF can be difficult given its often insidious onset of clinical and biochemical features.[3,4] NSAIDs such as ibuprofen can trigger a potentially life-threatening gastrointestinal bleeding in portal hypertension, including patients with CF-related liver disease.[5]

  We would suggest a careful exclusion of liver involvement using clinical examination, abdominal ultrasound and laboratory tests before advocating the use of high dose NSAIDs in CF patients.

  References

  (1) Arranz I. et al. Population pharmacokinetics of high dose ibuprofen in cystic fibrosis. Arch. Dis. Child. 88, 1128-1130 (2003).

  (2) Konstan MW, Byard PJ, Hoppel, CL and Davis PB. Effect of High-Dose Ibuprofen in Patients with Cystic Fibrosis. N Engl J Med 332, 848-854 (1995).

  (3) Colombo,C. et al. Liver disease in cystic fibrosis: A prospective study on incidence, risk factors, and outcome. Hepatology 36, 1374-1382 (2002).

  (4) Tanner, M.S. & Taylor, CJ. Liver disease in cystic fibrosis. Arch. Dis. Child 72, 281-284 (1995).

  (5) De Ledinghen,V. et al. Anti-inflammatory drugs and variceal bleeding: a case-control study. Gut 44, 270-273 (1999).

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  Conflict of Interest:
  None declared.

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