Bromfenac, diclofenac are most commonly linked to which idiosyncratic reaction?

• A. Allergic reactions/hypersensitivity
• B. Toxic epidermal necrolysis (SJS)
• C. Drug-induced liver injury
• D. Malignant hyperthermia

Answer: (C)

Drug-induced liver injury is the reaction most commonly linked to bromfenac and diclofenac. These NSAIDs can cause idiosyncratic hepatotoxicity in a subset of patients, and this risk is well documented for diclofenac in particular. The injury is not strictly dose-related; it stems from individual susceptibility and may involve reactive drug metabolites triggering immune‑mediated damage or metabolic stress in the liver. Clinically, patients may develop elevations in liver enzymes, jaundice, or cholestasis, and stopping the drug is crucial if liver injury is suspected.

While allergic or hypersensitivity reactions can occur with NSAIDs, they are less characteristic for these two drugs compared with liver injury. Severe skin reactions like Stevens-Johnson syndrome or toxic epidermal necrolysis can occur with various medications but are rare for bromfenac and diclofenac. Malignant hyperthermia is unrelated to NSAID use and is triggered by certain anesthetic agents, not these drugs.