Managing the adverse effects of nonsteroidal anti-inflammatory drugs

Patrignani, Paola; Tacconelli, Stefania; Bruno, Annalisa; Sostres, Carlos; Lanas, Fernando

doi:10.1586/ecp.11.36

Cited by 96 publications

(99 citation statements)

References 155 publications

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“…53,99,100 The appropriate use of NSAIDs involves tailoring treatment to the individual's gastrointestinal and cardiovascular risk profile. In 2009, the American College of Gastroenterology (ACG) issued guidelines for the prevention of NSAID-related ulcer complications and strategies for balancing gastrointestinal and cardiovascular benefits and risks.…”

Section: Guidelines For the Prevention Of Nsaid-associated Risksmentioning

confidence: 99%

NSAIDs for Musculoskeletal Pain Management: Current Perspectives and Novel Strategies to Improve Safety

Atchison¹,

Herndon²,

Rusie³

2013

JMCP

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and completed residency training in physical medicine and rehabilitation at The Ohio State University. Dr. Atchison has been in practice at academic medical centers for more than 20 years, serving on the faculty at the University of Kentucky and University of Florida before his appointment at Northwestern University. A recognized teacher and researcher in the field of pain management and rehabilitation, he has presented courses, lectures, and workshops nationally and internationally on pharmacological and nonpharmacological therapies, care of spinal injuries, and spinal manipulation. Dr. Atchison has led and participated in many research projects, including several funded by the National Institutes of Health. He has authored numerous research papers and book chapters, and he serves as a peer reviewer for the Archives of Physical Medicine and Rehabilitation. He has been a member of the editorial boards of the Supplement Policy Statement Standards for Supplements to the Journal of Managed Care PharmacySupplements to the Journal of Managed Care Pharmacy are intended to support medical education and research in areas of clinical practice, health care quality improvement, or efficient administration and delivery of health benefits. The following standards are applied to all JMCP supplements to ensure quality and assist readers in evaluating potential bias and determining alternate explanations for findings and results. 1. Disclose the principal sources of funding in a manner that permits easy recognition by the reader. 2. Disclose the existence of all potential conflicts of interest among supplement contributors, including financial or personal bias. 3. Describe all drugs by generic name unless the use of the brand name is necessary to reduce the opportunity for confusion among readers. 4. Identify any off-label (unapproved) use by drug name and specific off-label indication. 5. Strive to report subjects of current interest to managed care pharmacists and other managed care professionals. S14 Multitarget Drugs S15 Conclusions S15 References Target AudiencesThis CME/CE activity is designed to meet the educational needs of pharmacists, physicians, nurse practitioners, and nurses. Learning Objectives• Assess patient-specific risk factors in selecting NSAIDs for mild-to-moderate musculoskeletal pain • Incorporate risk/benefit analysis in decision making about NSAID use • Use evidence-based guidelines for selecting NSAID therapy and applying strategies to prevent complications • Evaluate the efficacy, safety, and pharmacological profile of new and emerging NSAID formulations Funding This supplement was funded by an independent educational grant to PRIME Education, Inc. (PRIME) from Iroko Pharmaceuticals, LLC. Accreditation StatementsIn support of improving patient care, PRIME Education, Inc. (PRIME) is accredited by the American Nurses Credentialing Center (ANCC), the Accreditation Council for Pharmacy Education (ACPE), and the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing educat...

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Section: Guidelines For the Prevention Of Nsaid-associated Risksmentioning

confidence: 99%

NSAIDs for Musculoskeletal Pain Management: Current Perspectives and Novel Strategies to Improve Safety

Atchison¹,

Herndon²,

Rusie³

2013

JMCP

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“…The probability of sufering severe adverse efects is correlated with the dose and the age of the patients, the elderly being more vulnerable. Lower starting doses and reduction of doses in patients at risk are good preventive strategies, but further studies are necessary in order to develop genetic or biochemical markers of NSAID toxicity, in order to beter anticipate the advent of an unwanted drug-induced adverse efect [5].…”

Section: Adverse Efects Of Nsaidsmentioning

confidence: 99%

Adverse Effects and Drug Interactions of the Non‐Steroidal Anti‐Inflammatory Drugs

Voștinaru¹

2017

Nonsteroidal Anti-Inflammatory Drugs

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The aim of this chapter is to increase the awareness of health-care professionals concerning potential adverse efects and drug interactions of non-steroidal anti-inlammatory drugs (NSAIDs), which are among the most widely prescribed medicines, globally. They have a variety of clinical applications due to their anti-inlammatory, analgesic, antipyretic, or antithrombotic efect, but these drugs are not entirely innocuous, since they could increase the risk of gastrointestinal and cardiovascular complications. Furthermore, the drugs from this class have the potential of altering the pharmacokinetics of associated drugs, and also pharmacodynamic interactions have been reported. The clinical signiicance, mechanisms, and epidemiology of the adverse efects and drug interactions of NSAIDs are presented in this chapter. Prevention strategies for particularly high-risk groups of patients are also exposed. Detailed and up-to-date information regarding the adverse efects and drug interactions of NSAIDs are needed for all healthcare professionals in order to maximize eicacy in treating various illnesses while minimizing the risks for the patients.

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“…This increase in prostaglandin production was associated with de novo production of new COX protein. Further, the H 2 receptor blockers are presently recommended for both the prevention and treatment of gastroduodenal ulcers associated with NSAID use (24) . Ranitidine is a histamine H 2 -receptor antagonist that inhibits stomach acid production.…”

Section: • Change In Phmentioning

confidence: 99%

“…This requires prophylaxis with antiulcer drugs. H 2 blockers are most widely prescribed drugs for NSAID-induced gastric lesions (24) . Ranitidine, a well known H 2 receptor antagonist, has proved effective in patients with gastric ulcers (5) .…”

Section: Introductionmentioning

confidence: 99%

ADMINISTRATION OF H2 BLOCKERS IN NSAID INDUCED GASTROPATHY IN RATS: effect on histopathological changes in gastric, hepatic and renal tissues

Manocha

Lal

Venkataraman

2016

Arq. Gastroenterol.

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-Background -Nonsteroidal anti-inflammatory drugs induces gastric mucosal lesions because of its acidic properties.Ranitidine, an H 2 receptor antagonist, has proved beneficial in patients with gastric ulcers. Objective -The present study was performed to assess the effect of administering ranitidine in Nonsteroidal anti-inflammatory drugs (diclofenac, nimesulide) induced gastropathy, and their effect on the histopathology of stomach, kidney and liver. Methods -Diclofenac, nimesulide, and ranitidine were administered in doses of 2, 4, and 6 mg/kg, p.o. once daily for 14 days, and their effect on gastric volume, acidity, mean ulcer number, and gastric pH. In addition, histopathological examination was also performed on sections of stomach, kidney and liver.Results -Following the administration of diclofenac or nimesulide, all the gastric parameters were significantly altered as well as the histopathology of stomach, liver and kidney. In the control group, the renal sections showed normal glomeruli with no thickening of glomerular basement membrane, while in diclofenac alone, nimesulide alone, and ranitidine with nimesulide groups, the thickening of glomerular basement membrane was observed. These alterations were observed to be reversed in the ranitidine with diclofenac group. In the sections from the liver, the control group showed anastomosing plates and cords of cuboidal hepatocytes with round well stained nuclei and abundant cytoplasm. In the ranitidine with diclofenac, and ranitidine with nimesulide groups, mild dilatation of sinusoids is seen coupled with prominence of central vein. In the diclofenac alone and nimesulide alone groups, the proximal and distal convoluted tubules show mild focal tubular necrosis. In the gastric sections, the control group showed several folds forming villi, and the epithelial lining surface of the mucosa. In the ranitidine with diclofenac, and ranitidine with nimesulide groups, the duodenum showed scattered inflammatory cells composed predominantly of lymphocytes. In diclofenac alone and nimesulide alone group, the sections from the gastric areas showed partial necrosis and mild chronic inflammation respectively. Conclusion -The study, therefore, has provided therapeutic rationale towards simultaneous administration of H 2 receptor blocker ranitidine with diclofenac to be more beneficial as compared to ranitidine with nimesulide, to minimise the gastric intolerance of diclofenac in long term treatment of inflammatory conditions. HEADINGS -Diclofenac. Ranitidine. Histamine H 2 antagonist. Stomach diseases. Non-steroidal anti-inflammatory agents.

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Managing the adverse effects of nonsteroidal anti-inflammatory drugs

Cited by 96 publications

References 155 publications

NSAIDs for Musculoskeletal Pain Management: Current Perspectives and Novel Strategies to Improve Safety

NSAIDs for Musculoskeletal Pain Management: Current Perspectives and Novel Strategies to Improve Safety

Adverse Effects and Drug Interactions of the Non‐Steroidal Anti‐Inflammatory Drugs

ADMINISTRATION OF H2 BLOCKERS IN NSAID INDUCED GASTROPATHY IN RATS: effect on histopathological changes in gastric, hepatic and renal tissues

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