Current trends in the prescription of non-steroidal anti-inflammatory drugs: A Pharmacoepidemiological Review

Abstract

Godfrey B.S. Iyalomhe, Sarah I. Iyalomhe, Folasade O. Enahoro and Okhemukhokho Okhiai

There has been considerable confusion and concern among some practitioners and patients with regard to the prescription, abuse and adverse effects caused by non-steroidal anti-inflammatory drugs (NSAIDs), particularly gastrointestinal (GI) irritation and hemorrhage. The aim of this pharmacoepidemiological review therefore is to highlight the current prescription guidelines and prescribing precautions to prevent potential adverse effects. A manual literature and internet (Google, Medline, Embase, HINARI, Cochcrane Database) search showed that NSAIDs are commonly used but have risks associated with them, including significant upper GI bleeding. The elderly, patients with a history of peptic ulcer disease (PUD) and those on anticoagulants are at high risk. Although Aspirin is cardioprotective, other NSAIDs can aggravate congestive cardiac failure (CHF) and hypertension, and are associated with adverse cardiovascular (CV) events such as myocardial infaration (MI) and atrial fibrillation or flutter. Hepatic damage from NSAIDs is rare but these agents should not be used in patients with cirrhosis to avoid bleeding and renal failure. Caution should be exercised when prescribing NSAIDs for patients with platelet dysfunction, those taking anticoagulants and immediately before surgery. Potential central nervous system (CNS) effects include aseptic meningitis, psychosis and tinnitus. Asthma may be induced or exacerbated by NSAIDs. Though NSAIDs are likely safe in pregnancy, they should be avoided at the first trimester and in the last 6-8 weeks of pregnancy to prevent spontaneous abortion and prolonged gestation. Ibuprofen, Indometacin and Naproxen are safe in breast feeding women. Public enlightenment and patient education about correct dosing and NSAID overdosage, are imperative.

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