Flupirtine associated acute liver failure- case from India and review of literature

We present the first case of fatality due to Flupirtine related acute liver failure from India. Flupirtine is an amino-pyridine with the centrally acting non-opioid analgesic property, used for acute and chronic pain. The drug is not used or approved in the United States and has restricted use status in the European Union due to severe hepatotoxicity and deaths or transplantation due to acute liver failure. Drug Council of India has not issued usage restriction or warnings regarding Flupirtine which is frequently used by physicians/orthopaedics and available over the counter. Unexpected and frequent hepatotoxicity of this drug, marketed for about 30 years needs caution, and safer analgesic use should be practiced.