NSAIDs are used throughout the World Health Organization three-step analgesic ladder, and are indicated for pain in all stages of malignancy. Side-effects are common with NSAIDs. Much has been written about NSAIDs and COX, since the discovery of COX-1 and COX-2 isoforms. How do you choose the appropriate NSAID? The choice of NSAID continues to be dependent upon associated gastroduodenal toxicity and the related risk factors of individual patients. Choosing the appropriate NSAID should minimize the likelihood of needing additional medications to manage adverse effects and symptoms caused by the NSAID therapy itself.
Goodman LS, Gilman A, Hardman JG, Limbird LE (eds.): Analgesic-antipyretic and anti-inflammatory agents. In Goodman & Gilman’s the Pharmacological Basis of Therapeutics. 9th Ed.New York: McGraw Hill, 1996: 617-624.
2.
Pace V: Use of nonsteroidal anti-inflammatory drugs in cancer. Palliative Medicine. 1995; 9: 273-286.
Simon LS, Weaver AL, Graham DY, et al.: Anti-inflammatory and upper gastro-intestinal effects of celeoxcib in rheumatoid arthritis. JAMA. 1999; 282: 1921-1922.
5.
Geis GS: Update on clinical developments with celecoxib, a new specific COX-2 inhibitor: What can we expect?Journal of Rheumatology. 1999; 56 (suppl): 31-36.
6.
Warner TD, Giuliano F, Vojnovic I, et al.: Nonsteroid drugs’ selectivities for cyclo-oxygenase-2 are associated with human gastrointestinal toxicity: A full in-vitro analysis. Proceedings of the National Academy of Sciences. 1999; 96: 7563-7568.
7.
Cryer B: Nonsteroidal anti-inflammatory drugs and gastrointestinal disease. In Feldman M, Sleisenger MH, Scharschmidt BF (eds.): Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 6th Ed.Philadelphia: W. B. Saunders, 1998: 343-357.
8.
Fosslien E: Adverse effects of nonsteroidal drugs on the gastrointestinal system. Ann Clin Lab Sci. 1998; 28: 67-81.
9.
Wallace JL: Distribution and expression of cyclo-oxygenase (COX) isoenzymes, their physiological roles, and the categorization of nonsteroidal anti-inflammatory drugs. Am J Med. 1999; 107(6A): 11S-16S.
10.
Lacy CF, Armstrong LL, Goldman MP, et al.: Drug Information Handbook 2000. 8th Ed.Lexi-Comp, American Pharmacy Association, 2000.
11.
Laine L, Harper S, Simon T, et al.: A randomized trial comparing the effect of rofecoxib, a cyclo-oxygenase 2-specific inhibitor, with that of ibuprofen on the gastroduodenal mucosa of patients with osteoarthritis. Gastroenterology. 1999; 117(4): 776-783.
12.
Jones MK, Wang H, Peskar BM, et al.: Inhibition of angiogenesis by nonsteroidal anti-inflammatory drugs: insight into mechanisms and implications for cancer growth and ulcer healing. Nat Med. 1999; 5(12): 1418-1423.
Schmassmann A, Peskar BM, Stettler C, et al.: Effects of inhibition of prostaglandin endoeroxide synthetase-2 in chronic gastrointestinal ulcer models in rats. Br J Pharmacol. 1998; 123: 795-804.
15.
Hawkey CJ: Nonsteroidal anti-inflammatory drug gastropathy. Gastroenterology. 2000; 119(2): 521-535.
16.
Sorenson HT, Mellemkjaer L, Blot WJ, Nielsen GL: Risk of upper gastrointestinal bleeding associated with use of low dose aspirin. Am J Gastroenterol. 2000; 95(9): 2218-2224.
17.
Silverstein FE, Graham DY, Senior JR, et al.: Misoprostol reduces serious gastrointestinal complications in patients with rheumatiod arthritis receiving nonsteroidal anti-inflammatory drugs. Ann Int Med. 1995; 123: 241-249.
