Seminars in Arthritis and Rheumatism
Volume 39, Issue 4 , Pages 294-312, February 2010

Nonsteroidal Anti-Inflammatory Drugs: Adverse Effects and Their Prevention

  • Harald E. Vonkeman, MD, PhD

      Affiliations

    • Rheumatologist, Epidemiologist, Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente Hospital Group and University of Twente, Enschede, The Netherlands
    • Corresponding Author InformationAddress reprint requests to H. E. Vonkeman, MD, PhD, Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente Hospital Group and University of Twente, PO Box 50.000, 7500 KA, Enschede, The Netherlands
    • ,
  • Mart A.F.J. van de Laar, MD, PhD

      Affiliations

    • Professor of Rheumatology, Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente Hospital Group and University of Twente, Enschede, The Netherlands

published online 29 September 2008.

Objectives

To discuss nonsteroidal anti-inflammatory drugs (NSAIDs), their history, development, mode of action, toxicities, strategies for the prevention of toxicity, and future developments.

Methods

Medline search for articles published up to 2007, using the keywords acetylsalicylic acid, aspirin, NSAIDs, cyclooxygenase 2, adverse effects, ulcer, and cardiovascular.

Results

NSAIDs are 1 of the oldest, most successful drugs known to modern medicine. They are effective for alleviating pain, fever, and inflammation by inhibiting prostaglandin synthesis. Aspirin, by its irreversible inhibition of blood platelet function, is also effective in the prevention of cardiovascular disease. NSAIDs may cause gastrointestinal ulcers, serious cardiovascular events, hypertension, acute renal failure, and worsening of preexisting heart failure. These adverse effects may be prevented by limiting NSAID dosage and duration and by performing individual risk assessments and treating patients accordingly. Those at risk for gastroduodenal ulcers may be treated with concomitant proton-pump inhibitors, misoprostol and/or COX-2 selective NSAIDs. Those at risk for cardiovascular events may be treated with naproxen and a proton-pump inhibitor or misoprostol, but should best avoid NSAID use altogether.

Conclusions

Physicians should always prescribe the lowest effective dose for the shortest possible time and must take into account both the gastrointestinal and the cardiovascular risks of individual patients when prescribing NSAIDs.

Keywords: NSAIDs, review, history, toxicity, prevention

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 There are no conflicts of interest and no sources of support.

PII: S0049-0172(08)00133-9

doi:10.1016/j.semarthrit.2008.08.001

Seminars in Arthritis and Rheumatism
Volume 39, Issue 4 , Pages 294-312, February 2010

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