Disease: Nonsteroidal Anti-inflammatory Drugs (NSAIDS) and Ulcers

    What are nonsteroidal anti-inflammatory drugs (NSAIDs)?

    Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed medications for the inflammation of arthritis and other body tissues, such as in tendinitis and bursitis. The also are used for minor aches and pains.

    Examples of NSAIDs include:

    • aspirin,
    • indomethacin (Indocin),
    • ibuprofen (Motrin),
    • naproxen (Naprosyn),
    • piroxicam (Feldene),
    • nabumetone (Relafen), and
    • Celecoxib (Celebrex).

    NSAIDs are available by prescription or without a prescription (over-the-counter). They also are ingredients in many over the counter medications used for colds and minor aches and pain. They are administered orally as capsules, tablets, liquids, or by injection (ketorolac , Toradol). Although not included in this review, NSAIDs also are used as eye drops for eye inflammation (for example, ketorolac tromethamine [Acular]).

    NSAIDs are taken regularly by approximately 33 million Americans and over 30 billion doses of NSAIDs are consumed annually in the United States.

    Learn more about: Coumadin | heparin

    What are the side effects of NSAIDs?

    The major side effects of NSAIDs are related to their effects on the stomach and bowels (gastrointestinal system). Some 10% to 50% of patients are unable to tolerate treatment with NSAIDs because of side effects, including abdominal pain, diarrhea, and upset stomach. Approximately 15% of patients on long-term treatment with NSAIDs develop a peptic ulcer (ulceration of the stomach or duodenum). Even though many of these patients with ulcers do not have symptoms and are unaware of their ulcers, they are at risk of developing serious ulcer complications such as bleeding or perforation of the stomach.

    The annual risk of serious complications is 1% to 4% with chronic treatment with NSAIDs. The risk of ulcers is higher in the elderly and individuals with rheumatoid arthritis, and those taking blood thinning medications (anticoagulants) such as warfarin (Coumadin) and heparin, or steroid-containing medications (for example, prednisone), and individuals with a prior history of bleeding ulcers. (The anticoagulants do not cause NSAID related ulcers. Rather they increase bleeding if NSAID-induced ulcers occur.)

    A prior history of ulcers is the most important predictor of NSAID-induced ulcers. Patients with heart disease who are taking aspirin for prevention of heart attacks also are at risk, and the risk of bleeding ulcers doubles if aspirin is combined with other NSAIDs.

    How do NSAIDs work and how do they cause stomach problems?

    Prostaglandins are natural chemicals that serve as messengers to promote inflammation. By inhibiting the body's production of prostaglandins, NSAIDs decrease inflammation and the symptoms and signs of inflammation, pain, tenderness, and fever. However, certain prostaglandins also are important in protecting the stomach lining from the corrosive effects of stomach acid as well as playing a role in maintaining the natural, healthy condition of the stomach lining. These protective prostaglandins are produced by an enzyme called Cox-1. By blocking the Cox-1 enzyme and disrupting the production of prostaglandins in the stomach, NSAIDs can cause ulcers and bleeding. Some NSAIDs have less effect on prostaglandins in the stomach than others, and, therefore, may have a lower risk of causing ulcers but the increased risk of ulcers still exists.

    If a stomach ulcer is detected, how is it treated?

    Treatment of NSAID-induced ulcers involves discontinuing the NSAID, reducing stomach acid with H2-blockers, for example, ranitidine (Zantac), cimetidine (Tagamet), famotidine (Pepcid), and nizatidine (Axid, Axid AR), or, more effectively, with proton pump inhibitors, such as omeprazole (Prilosec) or synthetic prostaglandins, specifically misoprostol (Cytotec). Since H. pylori bacteria is a common cause of ulcers, eradication of the bacteria with a combination of antibiotics also may promote ulcer healing.

    Learn more about: Zantac | Tagamet | Pepcid | Axid | Prilosec | Cytotec

    What are the side effects of NSAIDs?

    The major side effects of NSAIDs are related to their effects on the stomach and bowels (gastrointestinal system). Some 10% to 50% of patients are unable to tolerate treatment with NSAIDs because of side effects, including abdominal pain, diarrhea, and upset stomach. Approximately 15% of patients on long-term treatment with NSAIDs develop a peptic ulcer (ulceration of the stomach or duodenum). Even though many of these patients with ulcers do not have symptoms and are unaware of their ulcers, they are at risk of developing serious ulcer complications such as bleeding or perforation of the stomach.

    The annual risk of serious complications is 1% to 4% with chronic treatment with NSAIDs. The risk of ulcers is higher in the elderly and individuals with rheumatoid arthritis, and those taking blood thinning medications (anticoagulants) such as warfarin (Coumadin) and heparin, or steroid-containing medications (for example, prednisone), and individuals with a prior history of bleeding ulcers. (The anticoagulants do not cause NSAID related ulcers. Rather they increase bleeding if NSAID-induced ulcers occur.)

    A prior history of ulcers is the most important predictor of NSAID-induced ulcers. Patients with heart disease who are taking aspirin for prevention of heart attacks also are at risk, and the risk of bleeding ulcers doubles if aspirin is combined with other NSAIDs.

    How do NSAIDs work and how do they cause stomach problems?

    Prostaglandins are natural chemicals that serve as messengers to promote inflammation. By inhibiting the body's production of prostaglandins, NSAIDs decrease inflammation and the symptoms and signs of inflammation, pain, tenderness, and fever. However, certain prostaglandins also are important in protecting the stomach lining from the corrosive effects of stomach acid as well as playing a role in maintaining the natural, healthy condition of the stomach lining. These protective prostaglandins are produced by an enzyme called Cox-1. By blocking the Cox-1 enzyme and disrupting the production of prostaglandins in the stomach, NSAIDs can cause ulcers and bleeding. Some NSAIDs have less effect on prostaglandins in the stomach than others, and, therefore, may have a lower risk of causing ulcers but the increased risk of ulcers still exists.

    If a stomach ulcer is detected, how is it treated?

    Treatment of NSAID-induced ulcers involves discontinuing the NSAID, reducing stomach acid with H2-blockers, for example, ranitidine (Zantac), cimetidine (Tagamet), famotidine (Pepcid), and nizatidine (Axid, Axid AR), or, more effectively, with proton pump inhibitors, such as omeprazole (Prilosec) or synthetic prostaglandins, specifically misoprostol (Cytotec). Since H. pylori bacteria is a common cause of ulcers, eradication of the bacteria with a combination of antibiotics also may promote ulcer healing.

    Learn more about: Zantac | Tagamet | Pepcid | Axid | Prilosec | Cytotec

    Source: http://www.rxlist.com

    Prostaglandins are natural chemicals that serve as messengers to promote inflammation. By inhibiting the body's production of prostaglandins, NSAIDs decrease inflammation and the symptoms and signs of inflammation, pain, tenderness, and fever. However, certain prostaglandins also are important in protecting the stomach lining from the corrosive effects of stomach acid as well as playing a role in maintaining the natural, healthy condition of the stomach lining. These protective prostaglandins are produced by an enzyme called Cox-1. By blocking the Cox-1 enzyme and disrupting the production of prostaglandins in the stomach, NSAIDs can cause ulcers and bleeding. Some NSAIDs have less effect on prostaglandins in the stomach than others, and, therefore, may have a lower risk of causing ulcers but the increased risk of ulcers still exists.

    Source: http://www.rxlist.com

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