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Reducing clinically significant gastrointestinal toxicity associated with nonsteroidal antiinflammatory drugs.
Ann Pharmacother. 2004 Sep; 38(9):1469-81.AP

Abstract

OBJECTIVE

To evaluate the efficacy of treatment strategies to reduce clinically significant gastrointestinal adverse effects associated with nonsteroidal antiinflammatory drugs (NSAIDs).

DATA SOURCES

A MEDLINE search (1966-November 2003) was performed to identify relevant articles. Key search terms included proton-pump inhibitors, histamine H2 antagonists, misoprostol, cyclooxygenase-2 (COX-2) selective inhibitors, nonsteroidal antiinflammatory agents, stomach ulcer, prevention, and economics. Additional references were obtained from cross-referencing the bibliographies of selected articles.

STUDY SELECTION AND DATA EXTRACTION

All information obtained from the MEDLINE search was reviewed. To provide the most clinically relevant information, only randomized controlled trials are included in this review.

DATA SYNTHESIS

Clinically significant upper gastrointestinal adverse events, such as ulcers and ulcer complications, associated with NSAIDs are a cause of significant morbidity and mortality in the US. Interest in strategies to reduce the risk of these adverse events is high among clinicians and patients. Misoprostol, high-dose H2-receptor antagonists, proton-pump inhibitors, and COX-2 inhibitors have been shown to reduce this risk. Misoprostol and proton-pump inhibitors are more effective than H2-receptor antagonists; dose-related diarrhea limits the clinical utility of misoprostol. These strategies may not provide enough protection in patients taking concomitant low-dose aspirin therapy or patients with a history of ulcer complications.

CONCLUSIONS

COX-2 inhibitors and proton-pump inhibitors are effective and well-tolerated therapies to reduce clinically significant upper gastrointestinal adverse events associated with NSAIDs.

Authors+Show Affiliations

Specialized Resident in Primary Care, University of Iowa Hospitals and Clinics Care, University of Iowa Hospitals and Clinics, Iowa City, IA 52242-1009, USA.No affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Review

Language

eng

PubMed ID

15213313

Citation

Jacobsen, Ryan B., and Beth Bryles Phillips. "Reducing Clinically Significant Gastrointestinal Toxicity Associated With Nonsteroidal Antiinflammatory Drugs." The Annals of Pharmacotherapy, vol. 38, no. 9, 2004, pp. 1469-81.
Jacobsen RB, Phillips BB. Reducing clinically significant gastrointestinal toxicity associated with nonsteroidal antiinflammatory drugs. Ann Pharmacother. 2004;38(9):1469-81.
Jacobsen, R. B., & Phillips, B. B. (2004). Reducing clinically significant gastrointestinal toxicity associated with nonsteroidal antiinflammatory drugs. The Annals of Pharmacotherapy, 38(9), 1469-81.
Jacobsen RB, Phillips BB. Reducing Clinically Significant Gastrointestinal Toxicity Associated With Nonsteroidal Antiinflammatory Drugs. Ann Pharmacother. 2004;38(9):1469-81. PubMed PMID: 15213313.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reducing clinically significant gastrointestinal toxicity associated with nonsteroidal antiinflammatory drugs. AU - Jacobsen,Ryan B, AU - Phillips,Beth Bryles, Y1 - 2004/06/22/ PY - 2004/6/24/pubmed PY - 2004/10/27/medline PY - 2004/6/24/entrez SP - 1469 EP - 81 JF - The Annals of pharmacotherapy JO - Ann Pharmacother VL - 38 IS - 9 N2 - OBJECTIVE: To evaluate the efficacy of treatment strategies to reduce clinically significant gastrointestinal adverse effects associated with nonsteroidal antiinflammatory drugs (NSAIDs). DATA SOURCES: A MEDLINE search (1966-November 2003) was performed to identify relevant articles. Key search terms included proton-pump inhibitors, histamine H2 antagonists, misoprostol, cyclooxygenase-2 (COX-2) selective inhibitors, nonsteroidal antiinflammatory agents, stomach ulcer, prevention, and economics. Additional references were obtained from cross-referencing the bibliographies of selected articles. STUDY SELECTION AND DATA EXTRACTION: All information obtained from the MEDLINE search was reviewed. To provide the most clinically relevant information, only randomized controlled trials are included in this review. DATA SYNTHESIS: Clinically significant upper gastrointestinal adverse events, such as ulcers and ulcer complications, associated with NSAIDs are a cause of significant morbidity and mortality in the US. Interest in strategies to reduce the risk of these adverse events is high among clinicians and patients. Misoprostol, high-dose H2-receptor antagonists, proton-pump inhibitors, and COX-2 inhibitors have been shown to reduce this risk. Misoprostol and proton-pump inhibitors are more effective than H2-receptor antagonists; dose-related diarrhea limits the clinical utility of misoprostol. These strategies may not provide enough protection in patients taking concomitant low-dose aspirin therapy or patients with a history of ulcer complications. CONCLUSIONS: COX-2 inhibitors and proton-pump inhibitors are effective and well-tolerated therapies to reduce clinically significant upper gastrointestinal adverse events associated with NSAIDs. SN - 1060-0280 UR - https://www.unboundmedicine.com/medline/citation/15213313/Reducing_clinically_significant_gastrointestinal_toxicity_associated_with_nonsteroidal_antiinflammatory_drugs_ L2 - https://journals.sagepub.com/doi/10.1345/aph.1D621?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -