Complications of therapy
Nonsteroidal Anti-Inflammatory Drugs: Adverse Effects and Their Prevention

https://doi.org/10.1016/j.semarthrit.2008.08.001Get rights and content

Objectives

To discuss nonsteroidal anti-inflammatory drugs (NSAIDs), their history, development, mode of action, toxicities, strategies for the prevention of toxicity, and future developments.

Methods

Medline search for articles published up to 2007, using the keywords acetylsalicylic acid, aspirin, NSAIDs, cyclooxygenase 2, adverse effects, ulcer, and cardiovascular.

Results

NSAIDs are 1 of the oldest, most successful drugs known to modern medicine. They are effective for alleviating pain, fever, and inflammation by inhibiting prostaglandin synthesis. Aspirin, by its irreversible inhibition of blood platelet function, is also effective in the prevention of cardiovascular disease. NSAIDs may cause gastrointestinal ulcers, serious cardiovascular events, hypertension, acute renal failure, and worsening of preexisting heart failure. These adverse effects may be prevented by limiting NSAID dosage and duration and by performing individual risk assessments and treating patients accordingly. Those at risk for gastroduodenal ulcers may be treated with concomitant proton-pump inhibitors, misoprostol and/or COX-2 selective NSAIDs. Those at risk for cardiovascular events may be treated with naproxen and a proton-pump inhibitor or misoprostol, but should best avoid NSAID use altogether.

Conclusions

Physicians should always prescribe the lowest effective dose for the shortest possible time and must take into account both the gastrointestinal and the cardiovascular risks of individual patients when prescribing NSAIDs.

Section snippets

Methods

We searched Medline for English-language articles published up to 2007, using the keywords acetylsalicylic acid, aspirin, NSAIDs, cyclooxygenase-2, adverse effects, ulcer, and cardiovascular. The abstracts were screened for relevance and the publications relating to aspirin and NSAIDs were obtained. Additional references were identified from the bibliographies of the retrieved reports and from review articles. Further sources of information were retrieved from the internet.

The Age of Aspirin

The use of nonsteroidal anti-inflammatory substances predates the dawn of modern medicine. The earliest known references to the medicinal use of myrtle and willow tree bark, original sources of aspirin-like compounds, can be traced back to the ancient Egyptians. The application of willow tree bark for stiff and painful joints is recommended in the Ebers papyrus, a comprehensive 110-page medical text, containing 877 treatises on various physical, mental, and spiritual diseases, which is dated to

Discussion

In summary, NSAIDs are among the oldest, most successful drugs known to modern medicine. NSAIDs are effective for alleviating pain, fever, and inflammation, by inhibiting prostaglandin synthesis. Aspirin, by its irreversible inhibition of blood platelet function, is also effective in the secondary prevention and, in selected patients, primary prevention of cardiovascular disease. In addition, NSAIDs may also inhibit colorectal carcinogenesis.

NSAIDs are mainly indicated for mild to moderate pain

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