THERAPY WITH NONSTEROIDAL ANTIINFLAMMATOR Y DRUGS - RISK AND PREVENTION OF GASTROINTESTINAL ULCER

Nonsteroidal antiinflammatory drugs (NSAIDs) are among the most freque ntly prescribed drugs in western countries. The high incidence of adve rse gastrointestinal effects which are potentially life-threatening re quire steps for prevention. The use of NSAIDs should be restricted to patients with inflammatory reheumatic diseases. If NSAIDs are indicate d it is important to identify patients who are at high to develop seri ous gastrointestinal side effects. These patients should receive Misop rostol at a dose of 2 to 3 x 200 mu g per day. Up to date Misoprostol is the only drug with proven efficacy with respect to the prevention o f gastroduodenal ulcer and its complications. NSAIDs inhibit the key e nzyme of prostaglandin synthesis, the cyclooxygenase. Recently publish ed data show that 2 isoenzymes of the cyclooxygenase exists. Cyclooxyg enase-1 is primarily involved in the maintenance of organ function whe reas cyclooxygenase-2 is expressed in inflamed tissue. Specific cycloo xygenase-2 inhibitors have been developed. Clinical trials have to pro ve if the concept of a selective cyclooxygenase-2 inhibition with high antiinflammatory potency but lack of gastrointestinal side effects ho lds true in humans.