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

Implications for Clinical Practice

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Abstract

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.

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Acknowledgements

The study was sponsored by BIAL. Medical writing support for this manuscript was provided by Javier Mas. Native English editing support post-submission was provided by Raewyn Poole of inScience Communications, Springer Healthcare. This support was funded by BIAL Laboratories in Portugal. Dr José Patrício is an employee of BIAL. The other authors have no conflicts of interest that are related to the content of this review. All authors contributed equally to this article.

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  1. BIAL, Av da Siderurgia Nacional, Apartado 19, S. Mamede do Coronado, 4745-457, Trofa, Portugal

    José Pedro Henriques Patrício

  2. Centro Hospitalar de Lisboa Central, EPE (Hospital Curry Cabral, EPE), Lisbon, Portugal

    Jorge Pinto Pereira Barbosa

  3. Department of Gastroenterology, Centro Hospitalar Cova da Beira, EPE, Covilhã, Portugal

    Rui Miguel Monteiro Ramos

  4. Centro Hospitalar do Porto (Hospital de Santo António), Porto, Portugal

    Nuno Filipe Pimenta Antunes

  5. Instituto Português de Oncologia de Lisboa, Francisco Gentil, Lisbon, Portugal

    Pedro Carlos Santos de Melo

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Patrício, J.P.H., Barbosa, J.P.P., Ramos, R.M.M. et al. Relative Cardiovascular and Gastrointestinal Safety of Non-selective Non-steroidal Anti-inflammatory Drugs Versus Cyclo-oxygenase-2 Inhibitors. Clin Drug Investig 33, 167–183 (2013). https://doi.org/10.1007/s40261-013-0052-6

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