Therapy with NSAIDS, Coxibs & Aspirin

Aspirin, non-steroidal antiinflammatory drugs (NSAIDs) and more recently coxibs have revolutionised management of inflammatory and other connective tissue disorders. They have made a major contribution in their analgesic or pain relieving effect and also many are valuable in conditions such as migraine and dysmenorrhoea, while aspirin has useful antithrombotic actions in ischaemic heart disease.

Anti-inflammatories are the third most commonly prescribed group of drugs in Australia. Recently the association of Coxibs with the development of significant heart disease has resulted in the withdrawal of rofecoxib.The rate of anti-inflammatory use is increasing now that musculo-skeletal conditions account for 17.7% of all GP consultations. Aspirin has been available over the counter for many years andits use is high and probably underestimated.The widespread use of these medications means that their side effects present a common problem.To balance benefits and risks, all medications need continuous review. Accumulating information about the risks associated with anti-inflammatories means their use needs careful justification. With traditional NSAIDs, prophylaxis to prevent ulcers and complications may need consideration.Even low dose aspirin has a significant risk of causing peptic ulceration and bleeding.The COX-2 selective inhibitors have an improved gastrointestinal safety profile than non selective NSAIDs. These issues are particularly important in patients with existing or previouspeptic ulcers if they need antiinflammatories or aspirin.This overview discusses the benefits and risks of these anti-inflammatory agents and has been written to help doctors and pharmacists decide on their use in individual patients.To view the complete article please click here.