Safe use of non-steroidal antiinflammatory drugs

The beneficial and harmful effects of non-steroid anti inflammatory drugs (NSAID) are related to their inhibition of prostaglandin synthesis. The most common adverse effects of NSAID are symptomatic gastric or duodenal ulcer and cardiovascular conditions.

Patients at higher risk of gastrointestinal side effects are those over 65 years of age with a history of peptic ulcer and gastrointestinal bleeding, who have used glucocorticoid therapy and large daily doses of NSAID. As protective medication, proton pump inhibitors should be prescribed, especially for patients at high risk.  Both COX-1 and COX-2 inhibitors have cardiovascular adverse effects which may exceed the risk of gastrointestinal side effects. NSAIDs increase the risk of cardiac failure and vascular events (myocardical infarction, stroke). Overall cardiovascular risks are relatively small. Preexisting cardial failure increases the risk. Prescribing NSAID the careful assesment of benefits and risks involving gastrointestinal tract and cardiovascular system is needed in every case, especially in patients aged 65 or more. NSAID should be used in minimal effective doses and the indications of treatment should be checked regulary.