Hepatotoxic Assessment of Tramadol-Diclofenac Use: A Study in a Rat Model

Elias Adikwu, Ebinyo Clemente Nelson

Abstract


The concurrent use of tramadol and diclofenac may increase hepatotoxic risk due to their individual hepatotoxic effects. This study assessed the hepatotoxic effect of tramadol-diclofenac administration in albino rats. Twenty-four adult male albino rats (200-220g) randomized into four groups were orally administered with tramadol (12mg/kg/day), diclofenac (6mg/kg/day) and tramadol-diclofenac for 14 days respectively. The rats were anesthetized, blood samples were collected and evaluated for serum liver function and lipid parameters. Liver samples were weighed and evaluated for biochemical parameters and histology. The effects of tramadol-diclofenac on the body and liver weights did not differ significantly (p>0.05) when compared to control. Also, effects were not significant (p>0.05) on blood glucose, and serum cholesterol, triglyceride, low and high density lipoprotein cholesterol levels when compared to control. Liver and serum levels of aminotransferases, alkaline phosphatase, lactate dehydrogenase, gamma–glutamyl transferase, conjugated bilirubin and total bilirubin increased significantly in rats treated with tramadol (p<0.05), diclofenac (p<0.01) and tramadol-diclofenac (p<0.001) when compared to control. Furthermore, significant decreases in liver catalase, glutathione, superoxide dismutase, glutathione peroxidase levels with significant increases in malondialdehyde levels occurred in rats treated with tramadol (p<0.05), diclofenac (p<0.01) and tramadol-diclofenac (p<0.001) when compared to control. Hepatocyte necrosis was observed in rats treated with tramadol-diclofenac. Tramadol-diclofenac may increase hepatotoxic risk at doses used for this study.


Keywords


tramadol; diclofenac; co-treatment; toxicity; liver; rat

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References


Aebi H. Catalase in vitro, in Method in Enzymology, S. P. Colowick and N. O. Kaplane, Eds., 1984; Academic Press, New York, NY, USA.

Bailey AS, Zidell RH, and Perry RW. (2004). Relationships Between Organ Weight and Body/BrainWeight in the Rat: What Is the Best Analytical Endpoint? Toxicologic Pathology, 32:448–466,

Blondel RD L, (2013). Azadfard M, Wisniewski AM. Pharmacologic Therapy for Acute Pain Am Fam Physician, 87: 766-772.

Borković S S, Šaponjić JS, Pavlović S Z, Blagojević DP, Milošević S M, Kovačević TB et al. (2005). The activity of antioxidant defence enzymes in the mussel Mytilusgalloprovincialis from the Adriatic Sea. Comp. Bioch Physiol, 141: 366 – 374.

Buege J A and Aust S D. (1978). Microsomal Lipid Peroxidation. Methods Enzymol.52: 302-310

Castel JV, Gomez-Lechon, M J, Ponsoda X, Bort R (1997). The use of cultured hepatocytes to investigate the mechanism of drug hepatotoxicity. Cell Biol. Toxicol., (Review),13: 331-338

Connors AF Jr, Dawson NV, Desbiens NA (1995). A controlled trial to improve care for seriously ill hospitalized patients.The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT).The SUPPORT Principal Investigators. JAMA. 1995; 274: 1591–1598

Dubinsky RM, MiyasakiJ. (2010). Assessment: efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 74: 173–6.

Dunk AA, Walt RP, Jenkins WJ, Sherlock SS, (1982). Diclofenac hepatitis. Br. Med. J. 284: 160-166

El-Wessemy A M. (2008). Histopathological and ultra-structural studies on the side effects of the analgesic drug tramadol on the liver of albino mice. Egypt. J. Zool. 50: 423-442

Friedman LS, Martin P, Munoz SJ. (1996). Liver function tests and the objective evaluation of the patient with liver disease. In: Zakin D, Boyer TD, editors. Hepatology: A Textbook of Liver Disease. third ed. WB Saunders; Philadelphia: pp.791–833

Gaw A, Cowan RA, O’Reilly D St. J, Stewart MJ, Shepherd J. Clinical biochemistry an illustrated colour text. 2nd ed. Edinburgh: Harcourt Brace; 1999. p. 165

Gornall A G, Bardawill C J and David M M. (1949). Determination of serum proteins by means of the biureto reaction. J. Biol. Chem.177; 751-766.

Hussein AA, Hussein MA, Gaba EA Ahmed MR (2016). Hepatoprotective Effects of Cranberry Extract against Diclofenac Sodium Induced Liver Toxicity in Rats Int J Pharma Sci 6: 1447-1453

Jafari M, Salehi M, Ahmadi S, Asgari A, Abasnezhad M, Hajigholamali M. (2012). The role of oxidative stress in diazinon-induced tissues toxicity in Wistar and Norway rats.Toxicol Mech Methods, 22:638-47.

Jain R, Nandakumar K, Srivastava1 V, Vaidya SK, Patet S, Kumar P. (2008). Hepatoprotective activity of ethanolic and aqueous extract of Terminalia belerica in rats. Pharmacol onli 2: 411; 427

Loughrey MB, Loughrey CM, Johnston S, O'Rourke D. (2003). Fatal hepatic failure following accidental tramadol overdose. Forensic Sci Int, 134: 232-3.

Mitra S, Khandelwal P, Sehgal A. (2012). Diclofenac-tramadol vs. diclofenac-acetaminophen combinations for pain relief after caesarean section. Acta Anaesthesiol Scand. 56:706-11.

Raffa RB. (2001). Pharmacology of oral combination analgesics: rational therapy for pain. J Clin Pharm Ther. 26(4): 257–264.

Rawal N, Macquaire V, Catalá E, Berti M, Costa R, Wietlisbach M. (2011). Tramadol/paracetamol combination tablet for postoperative pain following ambulatory hand surgery: a double-blind, double-dummy, randomized, parallel-group trial. J Pain Res. 4:103–110.

Rosalki SB, Mcintyre N. Biochemical investigations in the management of liver disease. Oxford textbook of clinical hepatology, 2nd ed. New York; Oxford university press, 1999; 503-521.

Rotruck JT, Rope AL, Ganther HF, Swason AB. (1973). Selenium: biochemical role as a component of glutathione peroxidase. Science,179:588–90

Rukhshanda S, Razia I, Muhammad NA, Anum Z, Javed I and Muhammad SA. (2014). Effects of tramadol on histopathological and biochemical parameters in mice (Musmusculus) model.Global J Pharmacol.1:14-19.

Saukkonen JJ, Cohn DL, Jasmer RM, Schenker S, Jereb JA, et al. (2006). An Official ATS Statement: Hepatotoxicity of antituberculosis therapy. Am J RespirCrit Care Med, 174: 935-952.

Sedlak J and Lindsay RH. (1968). Estimation of Total, Protein-Bound, and Nonprotein Sulfhydryl Groups in Tissue with Ellman’s Reagent. Anal Biochem, 25: 1192-1205

Singhal PC, Sharma P, Kapasi AA, Reddy K, Franki N and Gibbons N. (1998). Morphine enhances macrophage apoptosis. Jour. of Immunology, 160: 1886-1893

Sun M and Zigma S. (1978). AnImprovedSpectrophotometer Assay of Superoxide Dismutase Based On Epinephrine Antioxidation. Anal Biochem. 90: 81-89

Tang W, Stearns RA, Bandiera SM, Zhang Y, Raab C, Braun MP, Dean DC, et al. (1999). Studies on cytochrome P-450-mediated bioactivation of diclofenac in rats and in human hepatocytes: Identification of glutathione conjugated metabolites. Drug Metab.Dispos. 27: 365-372.

Yousef MI, Omar SA, El-Guendi MI, Abdelmegid LA. (2010). Potential protective effects of quercetin and curcumin on paracetamol-induced histological changes, oxidative stress, impaired liver and kidney functions and haematotoxicity in rat Food Chem Toxicol, 48; 3246-3261

Zimmerman HJ. (1999). Drugs used to treat rheumatic and musculospastic disease. The NSAIDS.In, Zimmerman HJ. Hepatotoxicity: the adverse effects of drugs and other chemicals on the liver. 2nd ed. Philadelphia: Lippincott, pp. 1999; 517-41.




DOI: https://doi.org/10.14421/biomedich.2019.82.41-45

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Copyright (c) 2019 Elias Adikwu, Ebinyo Clemente Nelson



Biology, Medicine, & Natural Product Chemistry
ISSN 2089-6514 (paper) - ISSN 2540-9328 (online)
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