Managing the Adverse Effects of Nonsteroidal Anti-inflammatory Drugs

From Expert Review of Clinical Pharmacology Paola Patrignani; Stefania Tacconelli; Annalisa Bruno; Carlos Sostres; Angel Lanas Posted: 09/28/2011; Expert Rev Clin Pharmacol. 2011;4(5):605-621. © 2011 Expert Reviews Ltd. Abstract and Introduction Mechanism of Action of Nonsteroidal Anti-inflammatory Drugs GI Toxicity of NSAIDs CV Effects of NSAIDs COX-inhibiting NO Donators Managing GI Toxicity Management of GI Risk With Asprin Management of Patients With Peptic Ulcers or Dyspepsia Associated With NSAID Use NSAIDs & Lower GI Damage Managing CV Toxicity Expert Commentary Five-year View Abstract Conventional medical treatment for rheumatoid arthritis and osteoarthritis includes the use of NSAIDs (traditional and selective inhibitors of cyclooxygenase [COX]-2), because they provide unmistakable and significant health benefits in the treatment of pain and inflammation. However, they are associated with an increased risk of serious gastrointestinal (GI) and cardiovascular (CV) adverse events. Both beneficial and adverse effects are due to the same mechanism of action, which is inhibition of COX-dependent prostanoids. Since CV and GI risk are related to drug exposure, a reduction in the administered dose is recommended. However, this strategy will not eliminate the hazard owing to a possible contribution of individual genetic background. Further studies will be necessary to develop genetic and/or biochemical markers predictive of the CV and GI risk of NSAIDs. http://www.medscape.com/viewarticle/750226?src=mp&spon=27