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Misoprostol Briefly Counters Ibuprofen-Induced Renal Dysfunction in Cirrhotics

Ibuprofen causes renal dysfunction in decompensated cirrhotics but misoprostol may have some protective renal effects.

Yet, these are "short-lived and clinically insignificant," say researchers at the University of Virginia Health and Science Center, Charlottesville, Virginia and Hadassah University Hospital, Jerusalem, Israel. And because of side effects, misoprostol should be used "with caution" in patients with cirrhosis, they advise.

Noting that these patients are prone to develop renal failure when given nonsteroidal anti-inflammatory drugs, the researchers carried out a study to determine the safety and efficacy of misoprostol 400 micrograms in two repeated doses for the prevention of ibuprofen-induced renal function decrements in decompensated cirrhotics.

Patients were given ibuprofen 800 mg with either misoprostol (n = 9) or placebo (n = 10) and another dose one hour later. The researchers assessed renal function tests by clearance techniques.

Ibuprofen with placebo caused significant decreases in urinary output, insulin clearance, sodium excretion, osmolar clearance, free water clearance and urinary prostaglandin E₂ excretion.

Ibuprofen with the first misoprostol dose maintained urinary output and sodium excretion and caused free water clearance to increase. These changes lasted only one hour. The second misoprostol dose temporarily improved insulin and creatinine clearances.

Half the patients who received misoprostol suffered from chills, fever and diarrhoea.
American Journal of Gastroenterology 2002; 97(8):2033-2039. "Effect of misoprostol on ibuprofen-induced renal dysfunction in patients with decompensated cirrhosis: results of a double-blind placebo-controlled parallel group study"

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