non-steroidal anti-inflammatory agent (NSAID)

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Introduction

An aspirin-like drug that reduces pain & inflammation arising from injured tissue through inhibition of prostaglandin synthesis.

Indications

Contraindications

Cautions:

Dosage

(administration)

Pharmacokinetics

Monitor

Adverse effects

* NSAIDS may increase salt & water retention

* 10 days of NSAID therapy prior to interstitial nephritis[42]

Overdose:

Risk factors for adverse effects[3]

Drug interactions

Laboratory

Mechanism of action

More general terms

More specific terms

Additional terms

References

  1. ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 792
  2. ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 14, 598, 853
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2012, 2015, 2018, 2021.
  4. ↑ Prescriber's Letter 8(3):14 2001
  5. ↑ 5.0 5.1 5.2 Prescriber's Letter 9(5):29 2002
  6. ↑ 6.0 6.1 Journal Watch 23(8):63, 2003 Fiorucci S et al Gastrointestinal safety of NO-aspirin (NCX-4016) in healthy human volunteers: a proof of concept endoscopic study. Gastroenterology 124:600, 2003 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12612897
    Peura DA Mandate to modify a medicinal mantra: maybe not yet? Gastroenterology 124:842, 2003 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12612918
  7. ↑ Prescriber's Letter 10(10):58 2003
  8. ↑ 8.0 8.1 8.2 Journal Watch 24(14):109, 2004 Mamdani M, Juurlink DN, Lee DS, Rochon PA, Kopp A, Naglie G, Austin PC, Laupacis A, Stukel TA. Cyclo-oxygenase-2 inhibitors versus non-selective non-steroidal anti-inflammatory drugs and congestive heart failure outcomes in elderly patients: a population-based cohort study. Lancet. 2004 May 29;363(9423):1751-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15172772
  9. ↑ Prescriber's Letter 12(2): 2005 Update on the Safety and Use of COX-2 Inhibitors and Traditional NSAIDs Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=210202&pb=PRL (subscription needed) http://www.prescribersletter.com
  10. ↑ Prescriber's Letter 12(5): 2005 FDA Announces Important Changes and Additional Warnings for COX-2s and NSAIDs Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=210505&pb=PRL (subscription needed) http://www.prescribersletter.com
  11. ↑ FDA MedWatch COX-2 Selective (includes Bextra, Celebrex, and Vioxx) and Non-Selective Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) http://www.fda.gov/medwatch/SAFETY/2005/safety05.htm#NSAID
  12. ↑ 12.0 12.1 Journal Watch 25(13):102, 2005 Maiden L, Thjodleifsson B, Theodors A, Gonzalez J, Bjarnason I. A quantitative analysis of NSAID-induced small bowel pathology by capsule enteroscopy. Gastroenterology. 2005 May;128(5):1172-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15887101
  13. ↑ 13.0 13.1 Journal Watch 25(13):102, 2005 Hawkey C, Talley NJ, Yeomans ND, Jones R, Sung JJ, Langstrom G, Naesdal J, Scheiman JM; NASA1 SPACE1 Study Group. Improvements with esomeprazole in patients with upper gastrointestinal symptoms taking non-steroidal antiinflammatory drugs, including selective COX-2 inhibitors. Am J Gastroenterol. 2005 May;100(5):1028-36. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15842575
  14. ↑ 14.0 14.1 Journal Watch 25(16):126, 2005
    Hippisley-Cox J, Coupland C. Risk of myocardial infarction in patients taking cyclo- oxygenase-2 inhibitors or conventional non-steroidal anti- inflammatory drugs: population based nested case-control analysis. BMJ. 2005 Jun 11;330(7504):1366. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/15947398 <Internet> http://bmj.bmjjournals.com/cgi/content/full/330/7504/1366
  15. ↑ Prescriber's Letter 12(9): 2005 Non-narcotic Analgesics and the Risk of Hypertension in Women Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=210915&pb=PRL (subscription needed) http://www.prescribersletter.com
  16. ↑ 16.0 16.1 16.2 Gislason GH et al Increased mortality and cardiovascular morbidity associated with the use of nonsteroidal anti-inflammatory drugs in chronic heart failure. Arch Intern Med 2009 Jan 26; 169:141. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19171810
  17. ↑ 17.0 17.1 Rostom A et al. Canadian consensus guidelines on long-term nonsteroidal anti-inflammatory drug therapy and the need for gastroprotection: Benefits versus risks. Aliment Pharmacol Ther 2009 Mar 1; 29:481. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19053986
  18. ↑ 18.0 18.1 Prescriber's Letter 17(8): 2010 Managing NSAID Risks Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260810&pb=PRL (subscription needed) http://www.prescribersletter.com
  19. ↑ 19.0 19.1 19.2 Prescriber's Letter 18(12): 2011 NSAIDs and Hypertension Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=271224&pb=PRL (subscription needed) http://www.prescribersletter.com
  20. ↑ Johannesdottir SA et al Nonsteroidal anti-inflammatory drugs and the risk of skin cancer Cancer, May 29, 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22644960 <Internet> http://onlinelibrary.wiley.com/doi/10.1002/cncr.27406/abstract
  21. ↑ 21.0 21.1 Burmester G, Lanas A, Biasucci L et al The appropriate use of non-steroidal anti-inflammatory drugs in rheumatic disease: opinions of a multidisciplinary European expert panel. Ann Rheum Dis. 2011 May;70(5):818-22 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20833736
  22. ↑ Farkouh ME, Greenberg BP. An evidence-based review of the cardiovascular risks of nonsteroidal anti-inflammatory drugs. Am J Cardiol. 2009 May 1;103(9):1227-37. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19406264
  23. ↑ 23.0 23.1 Prescriber's Letter 21(3): 2014 NSAID Safety in Patients with Heart Disease Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=300322&pb=PRL (subscription needed) http://www.prescribersletter.com
  24. ↑ Antman EM, Bennett JS, Daugherty A et al Use of nonsteroidal antiinflammatory drugs: an update for clinicians: a scientific statement from the American Heart Association. Circulation. 2007 Mar 27;115(12):1634-42. Epub 2007 Feb 26. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17325246
  25. ↑ 25.0 25.1 25.2 Masclee GMC et al. Risk of upper gastrointestinal bleeding from different drug combinations. Gastroenterology 2014 Oct; 147:784 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24937265
    Laine L. NSAID-associated gastrointestinal bleeding: Assessing the role of concomitant medications. Gastroenterology 2014 Oct; 147:730. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25167988
  26. ↑ 26.0 26.1 FDA Drug Safety Alert. July 9, 2014 Non-aspirin Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Drug Safety Communication - FDA Strengthens Warning of Increased Chance of Heart Attack or Stroke http://www.fda.gov/Drugs/DrugSafety/ucm451800.htm http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm454141.htm
  27. ↑ 27.0 27.1 Yuan JQ et al. Systematic review with network meta-analysis: Comparative effectiveness and safety of strategies for preventing NSAID- associated gastrointestinal toxicity. Aliment Pharmacol Ther 2016 Jun; 43:1262 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27121479
  28. ↑ 28.0 28.1 28.2 Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
    Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
    Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  29. ↑ 29.0 29.1 Arfe A et al Non-steroidal anti-inflammatory drugs and risk of heart failure in four European countries: nested case-control study. BMJ 2016;354:i4857 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27682515 <Internet> http://www.bmj.com/content/354/bmj.i4857
    Gislason GH, Torp-Pedersen C NSAIDs and the failing heart BMJ 2016;354:i5163 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27681451 <Internet> http://www.bmj.com/content/354/bmj.i5163
  30. ↑ 30.0 30.1 Lin B, Curhan SG, Wang M et al Duration of Analgesic Use and Risk of Hearing Loss in Women. Am J Epidemiol (2016) 1-8. Published 14 December 2016 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27974293 https://academic.oup.com/aje/article/doi/10.1093/aje/kww154/2661733/Duration-of-Analgesic-Use-and-Risk-of-Hearing-Loss
  31. ↑ 31.0 31.1 Bally M, Dendukuri N, Rich B et al Risk of acute myocardial infarction with NSAIDs in real world use: bayesian meta-analysis of individual patient data. BMJ 2017;357:j1909 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28487435 <Internet> http://www.bmj.com/content/357/bmj.j1909
  32. ↑ 32.0 32.1 Therapeutics Letter #108. Therapeutics Initiative Drugs to Avoid. http://www.ti.ubc.ca/2018/01/04/108-drugs-avoid/
  33. ↑ 33.0 33.1 33.2 Dubreuil M, Louie-Gao Q, Peloquin CE, Choi HK, Zhang Y, Neogi T. Risk of myocardial infarction with use of selected non-steroidal anti-inflammatory drugs in patients with spondyloarthritis and osteoarthritis. Ann Rheum Dis 2018 Aug; 77:1137 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29674321 https://ard.bmj.com/content/77/8/1137
  34. ↑ Bouck Z, Mecredy GC, Ivers NM et al. Frequency and associations of prescription nonsteroidal anti- inflammatory drug use among patients with a musculoskeletal disorder and hypertension, heart failure, or chronic kidney disease. JAMA Intern Med 2018 Oct 8; PMID: https://www.ncbi.nlm.nih.gov/pubmed/30304456 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2705693
  35. ↑ 35.0 35.1 Nelson DA et al. Association of nonsteroidal anti-inflammatory drug prescriptions with kidney disease among active young and middle-aged adults. JAMA Netw Open 2019 Feb 15; 2:e187896 Not indexed in PubMed https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2724772
  36. ↑ Zhang X, Donnan PT, Bell S, Guthrie B. Non-steroidal anti-inflammatory drug induced acute kidney injury in the community dwelling general population and people with chronic kidney disease: systematic review and meta-analysis. BMC Nephrol. 2017 Aug 1;18(1):256. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28764659 Free PMC Article
  37. ↑ 37.0 37.1 37.2 Baccouche K, Alaya Z, Azzabi A et al Minimal-change disease and interstitial nephritis secondary to non-steroidal anti-inflammatory drugs (naproxen). Therapie. 2016 Oct;71(5):515-517. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27203163
  38. ↑ 38.0 38.1 FDA MedWatch. Oct 15, 2020 Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Drug Safety Communication
    Avoid Use of NSAIDs in Pregnancy at 20 Weeks or Later. https://www.fda.gov/safety/medical-product-safety-information/nonsteroidal-anti-inflammatory-drugs-nsaids-drug-safety-communication-avoid-use-nsaids-pregnancy-20
  39. ↑ 39.0 39.1 Amatruda JG et al. Association of non-steroidal anti-inflammatory drugs with kidney health in ambulatory older adults. J Am Geriatr Soc 2021 Mar; 69:726 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33305369 https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.16961
  40. ↑ 40.0 40.1 Bongiovanni T et al. Systematic review and meta-analysis of the association between non-steroidal anti-inflammatory drugs and operative bleeding in the perioperative period. J Am Coll Surg 2021 May; 232:765. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33515678 https://www.journalacs.org/article/S1072-7515(21)00048-X/fulltext
  41. ↑ 41.0 41.1 41.2 Windle ML Rapid Rx Quiz: Headache Medications Medscape. Sept 12, 2022 https://reference.medscape.com/viewarticle/980181
  42. ↑ 42.0 42.1 NEJM Knowledge+ Complex Medical Care
  43. ↑ 43.0 43.1 43.2 43.3 Davies NM. Toxicity of nonsteroidal anti-inflammatory drugs in the large intestine. Dis Colon Rectum. 1995 Dec;38(12):1311-21. PMID: https://www.ncbi.nlm.nih.gov/pubmed/7497845 Review.
  44. ↑ 44.0 44.1 Sunaga T, Yokoyama A, Nakamura S et al. Association of potentially inappropriate medications with all-cause mortality in the elderly acute decompensated heart failure patients: importance of nonsteroidal anti-inflammatory drug prescription. Cardiol Res. 2020;11(4):239-246 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32595809 PMCID: PMC7295559 Free PMC article
  45. ↑ Symptoms & Causes of Peptic Ulcers (Stomach Ulcers) https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/symptoms-causes

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