Review: The choice and cardiovascular safety of particular nonsteroidal anti-inflammatory drugs

Abstract

Nonsteroidal anti-inflammatory drugs (NSAIDs) are authorized for the relief of pain and inflammation in a wide range of conditions including the discomfort associated with headaches, osteoarthritis, rheumatoid arthritis, and menstrual pain and are available by prescription or over-the-counter (OTC). We reviewed common adverse effects of NSAIDs (especially those related to cardiovascular [CV] system) along with NICE (National Institute for Health and Care Excellence), EMA (European Medicines Agency), and the FDA (U.S. Food and Drug Administration) guidelines for safe and effective use of particular NSAIDs. Furthermore, we examined the NSAIDs market in Lithuania in a period between June 2016 and May 2017 and discussed how well recommendations mentioned above were followed. We emphasized that there was a high percentage of diclofenac prescribed in Lithuania while international guidelines encourage prescribing ibuprofen or naproxen for their relatively lower CV risk. Reviewing past trials, we observed that despite existing guidelines no single NSAID could be considered to be the safest one due to a lack of superiority trials. Seminars in Cardiovascular Medicine 2018; 24:16-21