Side effects of conventional nonsteroidal anti-inflammatory drugs and celecoxib: more similarities than differences.To the Editor: Cyclooxygenase-2 (COX-2) inhibitors are a new class of nonsteroidal anti-inflammatory drugs Nonsteroidal Anti-Inflammatory Drugs Definition
Nonsteroidal anti-inflammatory drugs are medicines that relieve pain, swelling, stiffness, and inflammation. (NSAIDs) with a reported benefit of less gastric and duodenal duodenal /du·o·de·nal/ (doo?o-de´n'l) (doo-od´ah-n'l) of or pertaining to the duodenum.
Refers to the duodenum, or the first part of the small intestine. ulceration. Nevertheless, it has been shown that COX-2 inhibitors are not completely "ulcer-proof." (1) Whereas the gastrointestinal side effects of NSAIDs are a matter of concern and interest, the cardiovascular and renal side effects of these drugs are less well appreciated. NSAIDs, including both conventional and COX-2 inhibitors, inhibit the synthesis of prostaglandins. Pathophysiologically, NSAIDs may increase blood pressure by renal and extrarenal mechanisms such as the reninangiotensin pathway, alterations in sodium and water retention, inhibition of vasodilating prostaglandins, and production of various vasoconstricting factors, including endothelin-1 and P450-mediated metabolites Metabolites
Substances produced by metabolism or by a metabolic process.
Mentioned in: Interactions of arachidonic acid. Thus, NSAIDs have been identified as risk factors for the development of hypertension. (2) Furthermore, NSAIDs antagonize the blood pressure-lowering effect of diuretics Diuretics Definition
Diuretics are medicines that help reduce the amount of water in the body.
Diuretics are used to treat the buildup of excess fluid in the body that occurs with some medical conditions such as congestive heart , [beta]-blockers, angiotensin-converting enzyme inhibitors Angiotensin-Converting Enzyme Inhibitors Definition
Angiotensin-converting enzyme inhibitors (also called ACE inhibitors) are medicines that block the conversion of the chemical angiotensin I to a substance that increases salt and water retention in the , and AT-2-blockers. (3) In addition, NSAIDs aggravate heart failure by inducing water retention and by blunting the effects of diuretics, [beta]-blockers, and angiotensin-converting enzyme inhibitors. (4) The prevalence of cardiovascular and renal side effects is relatively high and does not seem to differ between conventional NSAIDs and COX-2 inhibitors. A comparison of celecoxib with diclofenac in 287 patients with arthritis, cardiovascular and renal side effects were found in a total of 79 patients (27.8%). These side effects were hypertension (16.6%), peripheral edema (5.2%), and renal failure (6.0%) and did not differ between patient groups. (5) On the basis of these findings, we suggest that NSAIDs, regardless of whether they are conventional or COX-2 inhibitors, should be used with caution in patients with cardiovascular disorders and that NSAID NSAID: see nonsteroidal anti-inflammatory drug. intake should be considered a potential reason for aggravation of heart failure or increased blood pressure.
(1.) Crawford AS, White JG. Celecoxib-induced upper gastrointestinal hemorrhage and ulceration. South Med J 2002;95:1444-1446.
(2.) Curhan GC, Willett WC, Rosner B, et al. Frequency of analgesic analgesic (ăn'əljē`zĭk), any of a diverse group of drugs used to relieve pain. Analgesic drugs include the nonsteroidal anti-inflammatory drugs (NSAIDs) such as the salicylates, narcotic drugs such as morphine, and synthetic drugs use and risk of hypertension in younger women. Arch Intern Med 2002;162:2204-2208.
(3.) Fogari R, Zoppi A, Carretta R, et al; Italian Collaborative Study Group. Effect of indomethacin indomethacin /in·do·meth·a·cin/ (in?do-meth´ah-sin) a nonsteroidal antiinflammatory drug; used in the treatment of various rheumatic and nonrheumatic inflammatory conditions, dysmenorrhea, and vascular headache. on the antihypertensive antihypertensive /an·ti·hy·per·ten·sive/ (-ten´siv) counteracting high blood pressure, or an agent that does this.
Reducing high blood pressure.
n. efficacy of valsartan and lisinopril: A multicentre study. J Hypertens 2002;20:1007-1014.
(4.) Feenstra J, Heerdink ER, Grobbee DE, et al. Association of nonsteroidal anti-inflammatory drugs with first occurrence of heart failure and with relapsing heart failure: The Rotterdam Study. Arch Intern Med 2002;162:265-270.
(5.) Chan FK, Hung LC, Suen BY, et al. Celecoxib versus diclofenac and omeprazole in reducing the risk of recurrent ulcer bleeding in patients with arthritis. N Engl J Med 2002;347:2104-2110.
Claudia Stollberger, MD
Second Medical Department
Josef Finsterer, MD