Nonsteroidal anti-inflammatory drug adverse effects

Pharmacotherapy. Acute relief of inflammatory symptoms can be achieved by prostaglandin synthase inhibitors nonsteroidal anti-inflammatory drugs, or NSAlDs, such as diclofenac, indomethacin, piroxicam, p. 200), and glucocorticoids (p. 248). The inevitably chronic use of NSAlDs is likely to cause adverse effects. Neither NSAlDs nor glucocorticoids can halt the progressive destruction of joints. 

The primary adverse effect of intravenous cidofovir is a dose-dependent nephrotoxicity. Concurrent administration of other potentially nephrotoxic agents (eg, amphotericin B, aminoglycosides, nonsteroidal anti-inflammatory drugs, pentamidine, foscarnet) should be avoided. Prior administration of foscarnet may increase the risk of nephrotoxicity. Other potential side effects include uveitis, decreased intraocular pressure, and probenecid-related hypersensitivity reactions. Neutropenia and metabolic acidosis are rare. The drug caused mammary adenocarcinomas in rats and is embryotoxic. 

B. Adverse effects of nonsteroidal anti-inflammatory drugs... 

Murray MD, Brater DC. Adverse effects of nonsteroidal anti-inflammatory drugs on renal function. Ann Intern Med 1990 112(8) 559-60. 

Nonsteroidal anti-inflammatory drugs (NSAIDs) are medications that reduce swelling, pain, and stiffness without exposing the patient to the adverse side effects that occur when using corticosteroid medication. There are eight groups of NSAIDs. These are ... 

Despite the rigorous process for drug approval and regulation, several important medications have been removed from the market because of serious ADEs over the past 30 years. Examples of serious but uncommon effects include acute flank syndrome associated with suprofen," the gastrointestinal effects associated with nonsteroidal anti-inflammatory drugs (NSAIDs) in the elderly," troglitazone and the risk of hepatotoxicity," and the adverse effects of cisapride... 

As indicated above, combination opioids and ibuprofen are a more effective treatment for pain in selected patients with moderate to severe pain. Marret et al. [7] recently described the results of a meta-analysis of the effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on opioid dose and opioid-related adverse events. Their meta-analysis showed a significant 30% decrease in the incidence of post-operative nausea... 

Amphotericin B is the mainstay of treatment of patients with severe endemic fungal infections. The conventional deoxycholate formulation of the drug can be associated with substantial infusion-related adverse effects (e.g., chills, fever, nausea, rigors, and in rare cases hypotension, flushing, respiratory difficulty, and arrhythmias). Pre-medication with low doses of hydrocortisone, acetaminophen, nonsteroidal anti-inflammatory agents, and meperidine is common to reduce acute infusion-related reactions. Venous irritation associated with the drug can also lead to thrombophlebitis, hence central venous catheters are the preferred route of administration in patients receiving more than a week of therapy. 

Upon systemic distribution, many drugs evoke skin reactions that are caused on an immunological basis. Moreover, cutaneous injury can also arise from nonimmunological mechanisms. Cutaneous side effects vary in severity from harmless to lethal. Cutaneous reactions are a common form of drug adverse reaction. Nearly half of them are attributed to antibiotics or sulfonamides, and one-third to nonsteroidal anti-inflammatory agents, with many other pharmaceuticals joining the list... 

Although devil s claw has been studied for anti-inflammatory activity, notably in patients with arthritis, studies have indicated that devil s claw does not affect the biosynthesis of prostanoids, and thus is not expected to produce the adverse effects associated with nonsteroidal anti-inflammatory and glucocorticoid drugs (ESCOP 2003 Loew et al. 1996 Moussard et al. 1992 Whitehouse et al. 1983). 

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