The gastroduodenal toxicity of nonsteroidal anti-inflammatory drugs. A review of the literature

Nonsteroidal anti-inflammatory drugs (NSAIDs) are popular and important for the treatment of inflammation and pain. However, conventional NSAIDs are i ntrinsically toxic to the gastroduodenal (GD) mucosa. The literature can, a nd should, guide us towards safer prescribing of NSAIDs. Factors known to i ncrease the risk of GD toxicity include: history of peptic ulcer disease; a dvanced age; high doses; and coadministration of aspirin, anticoagulants or corticosteroids. Patients with any one of these,risk factors, with the pos sible exception of age alone, should receive gastroprotective prophylaxis w ith proton pump my inhibitors or misoprostol. Standard dose H2 antagonists do not protect against NSAID-induced gastric ulcers and are unsuitable for prophylaxis. Awareness of risk factors and appropriate prophylactic agents will minimize the risk to patients. whether the new generation of highly se lective COX-2 inhibitors and nitric oxide-donating-NSAIDs are safer drugs i n long-term abuse be remains to be proven, though initial clinical trial da ta are positive. (C) U.S. Cancer Pain Relief Committee, 2000.