drug to drug interactions involving NSAIDs Drug Affected NSAID Implicated Effect Warfarin NSAIDs that inhibit COX-1 Inhibits metabolism of warfarin; increases risk of bleeding owing to inhibition of platelet function and gastric mucosal damage Sulfonylurea High-dose salicylate Potentiates hypoglycemia Beta-blocker All PG-inhibiting NSAIDs Blunts hypotensive but not negative chronotropic or inotropic effect HydralazinePrazosinAngiotensin-converting enzyme inhibitor …
Why do the elderly tend to have more complications with NSAIDs? The elderly have more complications from these drugs than any other group of patients because of: • Altered drug absorption. The gastric pH rises with age. Active absorption and transport of drugs may be altered. • Reduced drug distribution. • Decreased protein-binding. Plasma albumin decreases with aging, …
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Different formulations of NSAIDs 1. Enteric-coated tablets. Enteric-coated ASA are supposed to have less GI symptoms than regular ASA, but there is no evidence that the enteric coating decreases gastritis or peptic ulcers. 2. Liquid formulations. Ibuprofen, naproxen, magnesium salicylate, and indomethacin are available in liquid formulations that are designed for patients who have difficulty swallowing pills and for …
Doses and plasma elimination half lives of the NSAIDs Drug Half-Life (hours) Dosage Short half-life (<6 hours)ASA 0.25 3000 mg divided (max daily dose) Diclofenac sodium (Voltaren)Diclofenac potassium (Cataflam) 1.1 25–50 mg bid–tid75 mg bid Diclofenac solumatrix (Zorvolex) 18–35 mg tid Etodolac (Lodine) 3.0/6.5 a 200 mg tid–qid400 mg tid Fenoprofen (Nalfon) 2.5 200–600 mg tid–qid Flurbiprofen …
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Rare side effects to NSAIDs 1. Febrile reactions—ibuprofen. 2. Mediastinal lymphadenopathy—sulindac. 3. Hematologic effects: aplastic anemia, pure red cell aplasia, thrombocytopenia, neutropenia—rare; reported with most NSAIDs (phenylbutazone removed from the market due to its association with hematologic effects). 4. Stomatitis—most NSAIDs. 5. Cutaneous effects: photosensitivity, urticaria/angioedema, erythema multiform, toxic epidermal necrolysis—most NSAIDs, especially piroxicam. 6. Aseptic meningitis (especially SLE patients)—ibuprofen, other …
Important considerations for the concurrent use of ASA and NSAIDs 1. Increased risk of GI toxicity; risk is increased five-fold over that with either agent alone. 2. With COX-2 selective inhibitors, concurrent use of ASA appears to abrogate the gastroprotective effects of selective COX-2 blockade. 3. Pharmacodynamic studies of ASA coadministration with ibuprofen and naproxen have demonstrated evidence …
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Strategies to reduce heart disease risk from NSAIDs in high risk • Take low-dose ASA >2 hours before an NSAID. • Do not use NSAIDs for 3 to 6 months after a CV event or procedure. • Avoid extended-release NSAID preparations. • Control blood pressure. • Limit dose and frequency of NSAIDs and consider alternative analgesics if possible. Several rheumatologic …
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