Which of the following NSAIDs can cause hepatic necrosis if used in overdose?
Paracetamol (Acetaminophen) It is metabolized to N-acetyl paraaminobenzo quinoneimine (NAPQ) by microsomal enzymes. This metabolite has high affinity for sulfhydryl groups and can combine with the enzymes and other biomolecules resulting in hepatotoxicity characterized by hepatic necrosis. Normally acetaminophen is a safe drug because glutathione (contain sulfhydryl group due to presence of sulfur containing amino acid, cysteine) produced by the liver combines with NAPQ to detoxify it. However chronic alcoholics are predisposed to toxicity Acetaminophen toxicity can be decreased by providing sulfhydryl donors like N-acetylcysteine (antidote of choice).
Diclofenac sodium
Acetaminophen
Indomethacin
Piroxicam
NSAIDs, Gout and Rheumatoid Ahritis