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Are we having an NSAIDS epidemic?


When the FDA approved over-the-counter sales of ibuprofen in 1984, the drug became one of the most widely used pain relivers in the United States. Sold under brand names such as Motrin, Advil, and Midol, ibuprofen is one of a family of drugs known as nonsterodial anti-inflammatory drugs, or NSAIDs, most of which are still available only by prescription. Stronger than aspirin, these drugs have a remarkable ability not only to relieve pain but also reduce inflammation in a host of conditions, including arthritis, painful menstrual periods, muscle aches, and headaches.

The drugs are especially useful in treating arthritis. They act specifically against the body's production of prostaglandins (PGs), those mysterious molecules that are somehow involved in all kinds of bodily processes--some good, some bad. In the kidney, for example, PGs are instrumental in maintaining adequate blood flow in the stomach, they protect its lining against the stomach acids. On the other hadn, PGs are somehow involved in the pathological process that leads to inflammation of joints (arthritis), tendons (tendonitis), and muscles (myositis). By inhibitng the production of Pgs, ibuprofen drugs relieve pain and promote healing in these inflammatory diseases--but in the process, they may produce undersirable and sometimes severe side effects by inhibiting the good PGs in the kidney and stomach.

NSAIDs are related to aspirin, and persons with a particular sensitivity to aspirin (the so-called aspirin syndrome, which produces asthma and nasal polyps) may not tolerate NSAIDs either. Similarly, some patients are susceptible to kidney or stomach damage as the result of the action of NSAIDs on the prostaglandins in those organs. Although they pose no great risk to young, healthy persons who use them intermittently, elderly patients may have more of a problem because they are more apt to have chronic arthritis and similar conditions requiring heavy and continous use of the drugs.

Although estimates place only 1 in 6,000 elderly patients on NSAIDs with gastrointestinal bleeding, the risk of this or other complications increases when more of these drugs are taken, especially for longer periods. Some relief seems now to be available in a new drug, misoprostol (Cytotec), which has recently received FDA approval. Related to the prostaglandin that keeps stomach acid in check, the drug has been shown to heal ulcers and related stomach lining damage caused by NSAIDs. It does, however, have some undesirable side effects of its own--and it is very expensive. For those who must take NSAIDs but who also suffer from their side effects, it may be a useful adjunct to therapy.

The common NSAIDs still requiring a prescription are naproxen (Naprosyn), piroxicam (Feldene), indomethacin (Indocin), tolmetin sodium (Tolectin), mefenamic acid (Ponstel), diflunisal (Dolobid), and diclofenac sodium (Voltaren). The risk of adverse reactions seems to rise with the daily doses of these drugs, and the elderly, as well as those having kidney disease, heart failure, excessively high blood pressure, or chronic heart disease, should be particularly careful about using over-the-counter ibuprofen. Also, ibuprofen should not be given to patients with ulcerative colitis, active peptic ulcer disease, or gastritis the drug should be used with caution if there is a history of these disorders. With proper medical supervision, however, these drugs can safely be used by persons who may not have previously obtained significant and lasting pain relief.
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Title Annotation:side effects of nonsteriodal anti-inflammatory drugs
Publication:Medical Update
Date:Feb 1, 1991
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