Each week we will aim to bring out a concise email that provides 4-5 key pieces of information addressing a specific issue in clinical therapeutics.
This week: NSAIDs
Na Lim, Clinical Pharmacist, Ward MM
Non-steroidal anti-inflammatory drugs (NSAIDs) are some of the most commonly used medicines. NSAIDs are often used for treatment and management of pain, especially pain due to inflammation and tissue injury such as osteoarthritis, rheumatoid arthritis and gout, as well as dysmenorrhea, migraine, and postoperative pain. Aspirin is also an NSAID, but tends to be better known for its use in low doses as an anti-platelet agent in cardiovascular disease. Common NSAIDs include ibuprofen (Nurofen®), celecoxib (Celebrex®), diclofenac (Voltaren®), and naproxen (Naprosyn®).
- Both selective (COX-2 inhibitors) and nonselective NSAIDs are associated with an increased risk of cardiovascular events, such as MI and stroke, even in healthy people. They can also worsen existing cardiovascular disease, e.g. by increasing BP and reducing renal function.
- Gastrointestinal toxicity with NSAIDs, including low-dose aspirin, is highest in patients with risk factors. These include increased age (>65 years), past history of peptic ulcer disease, heart disease, and co-prescription of antiplatelets, corticosteroids and anticoagulants. In addition, using higher doses of NSAIDs leads to an increased risk of upper gastrointestinal complications. Prolonged NSAID use and H. pylori infection are also associated with an increased risk of gastrointestinal toxicity.
- The elderly are especially more susceptible to increased risk of adverse effects of NSAIDs, in particular heart failure, GI ulceration and renal impairment.
- All NSAIDs can cause GI bleeding and the nonselective NSAIDs also affect platelet function; hence administration with other medications that affect the clotting process can increase the risk of bleeding.
Please consider these issues when preparing or interpreting RMMR reports or education sessions. Contributions of content or suggested topics are welcome and should be sent directly to firstname.lastname@example.org.