NSAIDs gastrointestinal adverse reactions

The anti-inflammatory effects of the NSAIDs are carried out by inhibition of COX-2. The gastrointestinal adverse reactions are caused by inhibition of COX-1. The newer NSAIDs (celecoxib and rofecoxib) appear to work by specifically inhibiting the COX-2 enzyme, without inhibiting the COX-1 enzyme. Celecoxib and rofecoxib relieve pain and inflammation with less potential for gastrointestinal adverse... 

The adverse effects profile does not differ from that of other propionic acid derivatives and includes the whole spectrum of gastrointestinal adverse reactions usually found with NSAIDs (SED-10, 166) (SEDA-10, 84) (4). The claim of good tolerance and gastric protection, based on animal data, which the company extrapolated to humans, has not been confirmed by appropriate clinical studies (SEDA-12, 89). 

Cyclo-oxygenase-2 (COX-2) selective inhibitors (coxibs) were developed because of reduced gastrointestinal adverse reactions compared with traditional non-selective NSAIDs, but later evidence suggested an increased cardiovascular risk [1, 2 ]. More information has recently been published about adverse events in patients taking COX-2 selective and non-selective NSAIDs. 

The indications and adverse reactions of sulindac are similar to those of other NSAIDs. In addition to its rheumatic disease indications, sulindac suppresses familial intestinal polyposis it may inhibit the development of colon, breast, and prostate cancer in humans. It appears to inhibit the occurrence of gastrointestinal cancer in rats. The latter effect may be caused by the sulfone rather than the sulfide. 

Etodolac This drug has effects similar to those of the other NSAIDs. Gastrointestinal problems may be less common. However, other adverse effects such as fluid retention and abnormal kidney and liver function have been reported. Etodolac may increase the serum levels and thus raise the risk of adverse reactions caused by digoxin, lithium, methotrexate, and enhance the nephrotoxicity of cyclosporine. 

Nonacidic drugs. COXIBs are associated with fewer gastrointestinal adverse effects, but otherwise the general profile of adverse reactions to NSAIDs applies. The possibility that COXIBs may be associated with increased risk of thrombotic cardiovascular events is the subject of pharmacovigilance studies. 

Lonazolac, an arylacetic acid derivative, causes adverse effects like those of other NSAIDs. Gastrointestinal disturbances are followed in frequency by nervous system and skin reactions. The extent of gastrointestinal blood loss is similar to that with diclofenac (1). Cholestatic hepatitis has also been reported (SEDA-8, 106). 

Monitoring and Managing Adverse Reactions It is important to observe the patient receiving an NSAID for adverse drug reactions tliroughout tlierapy. Because tliese dru have many adverse reactions, tlie nurse notifies the primary healtli care provider of any complaints tlie patient may hava Gastrointestinal reactions are the most common and can be severe and sometimes fatal, especially in those prone to upper gastrointestinal diseasa... 

The NSAID dexindoprofen has a similar adverse effect pattern to the parent drug, indoprofen. Gastrointestinal, nervous system, and skin reactions are the most frequent (1). 

ADRs are certainly the most important form of iatrogenic (i.e. doctor-induced) disease. Many of the serious reactions that occur are well-recognised and potentially preventable - e.g. bleeding with warfarin, the upper gastrointestinal effects of NSAIDs. In public health terms, it is not newly introduced drugs that are responsible for most of the population burden of adverse drugs reactions but those whose safety profile is well-established (see below). 

---