Clinical Drug Investigation

, Volume 33, Issue 3, pp 167–183

Relative Cardiovascular and Gastrointestinal Safety of Non-selective Non-steroidal Anti-inflammatory Drugs Versus Cyclo-oxygenase-2 Inhibitors

Implications for Clinical Practice


  • Jorge Pinto Pereira Barbosa
    • Centro Hospitalar de Lisboa CentralEPE (Hospital Curry Cabral, EPE)
  • Rui Miguel Monteiro Ramos
    • Department of GastroenterologyCentro Hospitalar Cova da Beira, EPE
  • Nuno Filipe Pimenta Antunes
    • Centro Hospitalar do Porto (Hospital de Santo António)
  • Pedro Carlos Santos de Melo
    • Instituto Português de Oncologia de Lisboa, Francisco Gentil
Review Article

DOI: 10.1007/s40261-013-0052-6

Cite this article as:
Patrício, J.P.H., Barbosa, J.P.P., Ramos, R.M.M. et al. Clin Drug Investig (2013) 33: 167. doi:10.1007/s40261-013-0052-6


Non-steroidal anti-inflammatory drugs (NSAIDs) are frequently used in clinical practice, and are considered a first-line option for pain management. However, non-selective NSAIDs (nsNSAIDs) and new generation NSAIDs named cyclo-oxygenase-2 inhibitors (coxibs) are very different from one another and their cardiovascular and gastrointestinal safety profiles may influence prescribing. This article resulted from a search of MEDLINE/Pubmed, Cochrane Library, Bandolier, Medscape and Trip database, up to June 2011. Key words included non-steroidal anti-inflammatory, coxib and safety, with the purpose of reviewing the gastrointestinal and cardiovascular safety issues of NSAIDS and the main aspects that differentiate both classes. Selective coxibs are associated with a more favourable gastrointestinal safety profile than nsNSAIDs. In terms of the risk of cardiovascular events, there seems to be a class effect for all NSAIDs with the possible exception of naproxen. The proper usage guidelines for NSAIDs detail the importance of risk factors for each patient in addition to the differences between classes. Patients with high cardiovascular or gastrointestinal risk should avoid using NSAIDs. These medications should be used at the minimum effective dose and for the shortest time possible in all patients.

Copyright information

© Springer International Publishing Switzerland 2013