NSAIDs aspirin

Nonnarcotic analgesics. The nonnarcotic analgesics include aspirin, NSAIDs, and acetaminophen. Aspirin acts centrally and peripherally to block the transmission of pain impulses. Furthermore, it reduces fever and inflammation and inhibits synthesis of the prostaglandins that increase the sensitivity of nociceptors. 

Concomitant therapy - Aspirin, NSAIDs, and/or low-dose steroids may be continued, although the possibility of increased toxicity with concomitant use of NSAIDs, including salicylates, has not been fully explored. Steroids may be reduced gradually in patients who respond to methotrexate. Combined use of methotrexate with... 

The primary difference between aspirin and other NSAIDs is cost. Most of the NSAIDs still require a physician s prescription. The cost of prescription NSAIDs can be anywhere from 10 to 20 times more expensive than an equivalent supply of aspirin. NSAIDs that are available in nonprescription form (e.g., ibuprofen) can still cost up to five times as much as aspirin. 

Moyad MM An introduction to aspirin, NSAids, and COX-2 inhibitors for the primary prevention of cardiovascular events and cancer and their potential preventive role in bladder carcinogenesis part II. Semin Urol Oncol. 2001 19 306-316. 

ASA = aspirin NSAIDs = non-steroidal anti-inflammatory drugs, such as ibuprofen, naproxen, and diclofenac CNS stimulants include drugs such as pseudoephedrine, dextroamphetamine, theophylline, and caffeine MAO = monoamine oxidase CNS depressants include drugs such as benzodiazepines, barbiturates, and ethanol SSRIs = selective serotonin reuptake inhibitors, such as fluoxetine, sertraline, and paroxetine. Antidiabetic agents include drugs such as insulin, glipizide, glyburide, and metformin. 

It is important to note that withdrawal of medications may also lead to ADR. Certain settings (e.g., LTCF) encourage prescribers to remove medications, some of which may have been used by the patient for many years. If the withdrawal of therapy is not appropriate or is done too quickly, this may cause ADR for the patient. The most common drugs involved in ADRs are cardiovascular medications, aspirin, NSAIDs, and psychotropic agents. However, it should be noted that these are also the most commonly used medications in the elderly. ... 

In an 11-year observational study in new users of non-selective, non-aspirin NSAIDs (n — 181 441) and an equal number of non-users there was no evidence of a protective effect of naproxen (50). During 532 634 person-years of follow-up there were 6382 cases of serious coronary heart disease (11.9 per 1000 person-years). Multivariate-adjusted rate ratios for current and former use of non-aspirin NSAIDs were 1.05 (95% Cl = 0.97, 1.14) and 1.02 (0.97, 1.08) respectively. Rate ratios for ibuprofen, naproxen, and other NSAIDs were 1.15 (1.02, 1.28), 0.95 (0.82, 1.09), and 1.03 (0.92, 1.16) respectively. There was no protection in long-term users with uninterrupted use the rate ratio among current users with more than 60 days of continuous use was 1.05 (0.91,1.21). When naproxen was directly compared with ibuprofen, the rate ratio in current users was 0.83 (0.69, 0.98). This study therefore seems to have shown no cardioprotective effect of naproxen. However, the study had a number of important limitations, including lack of information about some important confounders (smoking, obesity), possible exposure misclassification, and lack of information about over-the-counter use of aspirin. 

This study has therefore shown that in patients infected with H. pylori who take low-dose aspirin, eradication of H. pylori is as effective as prophylactic therapy with omeprazole in preventing recurrent upper gastrointestinal bleeding. Therefore, patients taking aspirin for cardiovascular prophylaxis could be tested for H. pylori infection and treated for it if infection is confirmed. In contrast, omeprazole is superior to eradication of H. pylori for the secondary prevention of upper gastrointestinal bleeding in H. py/on-infected users of naproxen and presumably other non-aspirin NSAIDs. 

Conclusions Whether the eradication of H. pylori can reduce the risk of ulcers appears to vary according to the characteristics of the patient. For people who have never taken a non-aspirin NSAID, eradication of H. pylori before NSAID treatment is begun reduces the risk of ulcers (100). However, for long-term users of non-aspirin NSAIDs, eradication of H. pylori has not been shown to prevent gastroduodenal injury. Moreover, eradication alone is not sufficient to prevent recurrent bleeding in susceptible long-term users. 

Waterhouse DM, Brenner D. Aspirin, NSAIDs, and risk reduction of colorectal cancer. The problem is translation. Arch Intern Med 1994 154(4) 366-8. 

A partial list of those drugs that can cause pruritus are as follows aspirin, NSAIDs, penicillins, sulfonamides,... 

Aspirin, NSAIDs (cyclooxygenase inhibitors), sulfites, benzalkonium chloride, jS-blockers Occupational stimuli... 

Anabolic steroids, aspirin, NSAIDs, quinidine, thyroxine Increased anticoagulant effects via pharmacodynamic mechanisms... 

Early studies evaluating non-aspirin NSAIDs in rheumatoid arthritis commonly permitted the concurrent use of aspirin, which was then in wide use for this condition. The unexpected finding that indometacin was no more effective than placebo in patients taking aspirin in one study led to a number of pharmacokinetic studies with this combination (see Indometacin, below), and subsequently other NSAID/aspirin combinations. These studies generally have little clinical relevance to current clinical practice where anti-inflammatory doses of aspirin should not be used in combination with NSAIDs because of the increased risk of gastrointestinal bleeding (see above) and lack of proven additional benefit. However, the pharmacokinetic studies are briefly summarised below. 

Retrospective cohort Discharge after Ml Death in first year Aspirin alone (36211) NSAID alone (736) Aspirin with NSAID (2096) Neither (9541) Risk of death reduced to a similar extent by aspirin, NSAIDs, and the combination. 4... 

The risk of serious upper gastrointestinal bleeding was inereased by the use of more than one NSAID in a meta-analysis of data from three ease-eontrolled studies (odds ratio 4.9 with one NSAID and 10.7 with two). Another study provided similar findings the odds ratio was 7.1 with one NSAID and 12.3 with two or more NSAIDs. Similar findings have been reported with aspirin and NSAIDs, see NSAIDs + Aspirin Anti-inflammatory dose , p.l42. Analysis of yellow eard reports to the CSM in the UK, of gastrointestinal perforation, obstruetion, uleeration or bleeding with diclofenac, naproxen, and ibuprofen, revealed that 6% of the patients were reeeiving another non-aspirin NSAID. ... 

Committee on the Safety of Medicines/Medicines Control Agency. Relative safety of oral non-aspirin NSAIDs, Current Problems (1994) 20,9-11. 

Immunologic The safety of meloxicam has been studied in 116 patients with aspirin/ NSAID-associated urticaria or angioedema, who underwent a single-blind, placebo-controlled oral challenge with meloxicam (7.5 mg cumulative dose) [40 ]. There were no reactions in 106 patients. Five patients developed pruritus or erythema and five developed localized angioedema with erythema. Reactions to meloxicam were milder than the patients previous reactions. 

There is some evidence that the lenkotrienes are major mediators of clinical symptoms seen in asthma exacerbated by aspirin/ NSAIDs, and this evidence has been bolstered by the important finding of over-expression of LTC4 synthase in bronchial biopsies from patients with aspirin-intolerant asthma. 

Aspirin, NSAIDs, COX-2 inhibitors may enhance antiplatelet effects and increase anticoagulation (including with vit Kantagonists). 

Aspirin, NSAiDs, COX-2 inhibitors - can enhance antiplatelet effects and anticoagulant effects (vit K antagonists). 

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