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NSAIDs Side Effects
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Nonsteroidal anti-inflammatories, including aspirin and ibuprofen, are the most commonly prescribed medicines across the world. While they relieve aches, pains and are used to reduce joint inflammation seen with arthritis, they do increase the risk of stomach ulcers and gi bleeding. About 1% to 4% of NSAID users experience gi complications. Cox-2 inhibitors, a class of NSAIDs were development to reduce gi side effects. In the late 1990’s two Cox-2 inhibitors, Vioxx and Celebrex became two of the most prescribed medicines. After reports of Vioxx-related cardiovascular complications began to surface, the medicine was withdrawn from the market.
The American Gastroenterology Association now recommends care be taken prior to the decision to prescribe NSAIDs. Specifically, in a summary statement from the organization, it has been recommended that a careful balance be achieved between the benefits of the medicine and it potential cardiovascular and gi complications.
The association recommends stratifying patients into high or low risk for gi bleeding.
Those with a previous history of peptic ulcer or Helicobacter pylori infection, history of NSAID-related gastric irritation, and the use of a combination of NSAIDs should be screened and treated for helicobacter pylori and receive an agent that protects the stomach’s lining.
It was also recommended that patients who are at greater risk of GI bleeding should receive NSAIDs with lower GI risks, such as COX-2 inhibitors, if their cadiovascular risk is minimal. Patients with a greater risk of cardiovascular problems should avoid COX-2 inhibitors and receive low-dose aspirin which is known to be cardioprotective. These new recommendations should significantly reduce the gi and cardiovascular complications that are associated with NSAIDs.
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