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Dr Graham objects to my suggestion of "careful and serial" monitoring of liver functions, suggesting that this wording places an unnecessary burden on the prescribing physician and indeed may make him or her more liable to litigation.As part of my conclusion, I stated, "We would be well advised, then, to monitor liver functions (especially the transaminases) carefully and serially in any patient undergoing long-term NSAID therapy." I further recommended baseline liver profile studies in any individual suspected to be at risk for hepatic injury (as briefly outlined, alcohol or other drug abusers, those debilitated or immunocompromised, those testing positive for the human immunodeficiency virus or at risk for the acquired immunodeficiency virus, those with a history of foreign travel, those exposed to toxic industrial products or hepatitis, those receiving blood transfusions, or those with a "chronic pain" problem with attendant "overmedication," either "self" or iatrogenic.Dr Graham
Gay GR. Monitoring for Side Effects of NSAIDs-Reply. JAMA. 1991;265(15):1951. doi:10.1001/jama.1991.03460150054017