CNS ADVERSE-EFFECTS OF NONSTEROIDAL ANTIINFLAMMATORY DRUGS - THERAPEUTIC IMPLICATIONS

It is difficult to obtain valid estimations of the true incidence of C NS effects associated with nonsteroidal anti-inflammatory drugs (NSAID s) from spontaneously reported adverse reactions. This is because the reporting rates of adverse reactions are low and the total number of i ndividual drugs prescribed is not generally documented. However, some prospective studies have validated an association between NSAIDs and C NS adverse effects. Aseptic meningitis is the most widely recognised C NS adverse effect associated with NSAIDs. In several case studies, the association has been validated by rechallenge with the NSAID in quest ion. Patients with systemic lupus erythematosus are at an increased ri sk of NSAID-induced aseptic meningitis, and the meningitis may be a sp ecific cell-mediated immune response. Evidence for an association betw een NSAIDs and psychiatric adverse effects is mainly anecdotal and com es from spontaneous reports. in some cases, rechallenge with the NSAID strengthens the association. Cognitive dysfunction is also reported, most commonly with indomethacin, with some prospective studies strengt hening this association. In contrast, other studies report beneficial CNS effects of NSAIDs, including improvement in short term memory and a protective effect in Alzheimer's disease. In patients presenting wit h meningitis-like symptoms, NSAID use should be considered at a possib le precipitating factor. The possibility of NSAID use as an exacerbati ng factor in psychiatric and cognitive dysfunction should also be cons idered, particularly in the elderly.