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M. Langman (1988)
Ulcer complications and nonsteroidal anti-inflammatory drugs.The American journal of medicine, 84 2A
Talseth T Berg KJ (1985)
Acute renal effects of sulindac and ibuprofen in chronic renal failureClin Pharmacol Ther., 37
Donald Miller (1981)
Combination Use of Nonsteroidal Anti Inflammatory DrugsAnnals of Pharmacotherapy, 15
J. Fries, Catherine Williams, D. Bloch, B. Michel (1991)
Nonsteroidal anti-inflammatory drug-associated gastropathy: incidence and risk factor models.The American journal of medicine, 91 3
Porro GB Caruso I (1980)
Gastroscopic evaluation of antiinflammatory agentsBMJ., 280
N. Fisher, D. Pendergast, G. Gresham, E. Calkins, E. Calkins (1991)
Muscle rehabilitation: its effect on muscular and functional performance of patients with knee osteoarthritis.Archives of physical medicine and rehabilitation, 72 6
M. Griffin, J. Piper, J. Daugherty, M. Snowden, W. Ray (1991)
Nonsteroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons.Annals of internal medicine, 114 4
F. Silverstein, A. Feld, D. Gilbert (1981)
Upper Gastrointestinal Tract Bleeding: Predisposing Factors, Diagnosis, and TherapyJAMA Internal Medicine, 141
Miller DR (1981)
Combination use of nonsteroidal antiinflammatory drugsDrug Intell Clin Pharm., 15
Jacques Caldwell, Sanford Roth, Wallace Wu, Elliott Semble, Donald Castell, Matthew Heller, William Marsh (1987)
Sucralfate treatment of nonsteroidal anti-inflammatory drug-induced gastrointestinal symptoms and mucosal damage.The American journal of medicine, 83 3B
A. Kamper, S. Strandgaard, P. Christensen, U. Svendsen (1986)
Effects of sulindac and naproxen in patients with chronic glomerular disease.Scandinavian journal of rheumatology. Supplement, 62
Roth S Agrawal NM (1991)
Misoprostol compared with sucralfate in the prevention of non-steroidal anti-inflammatory drug-induced gastric ulcerAnn Intern Med., 115
B. Bloom (1988)
Direct medical costs of disease and gastrointestinal side effects during treatment for arthritis.The American journal of medicine, 84 2A
Sanford Roth, R. Bennett, C. Mitchell, Ruby Hartman (1987)
Cimetidine therapy in nonsteroidal anti-inflammatory drug gastropathy. Double-blind long-term evaluation.Archives of internal medicine, 147 10
R. Ehsanullah, M. Page, G. Tildesley, J. Wood (1988)
Prevention of gastroduodenal damage induced by non-steroidal anti-inflammatory drugs: controlled trial of ranitidine.British Medical Journal, 297
F. Mcduffie (1985)
Morbidity impact of rheumatoid arthritis on society.The American journal of medicine, 78 1A
Committee on Safety of Medicines (1986)
Non-steroidal anti-inflammatory drugs and serious gastrointestinal adverse reactions, IBMJ., 292
Richard Day, Garry Graham, Kenneth Williams, G. Champion, Julien Jager (1987)
Clinical pharmacology of non-steroidal anti-inflammatory drugs.Pharmacology & therapeutics, 33 2-3
J. Piper, W. Ray, J. Daugherty, M. Griffin (1991)
Corticosteroid use and peptic ulcer disease: role of nonsteroidal anti-inflammatory drugs.Annals of internal medicine, 114 9
D. Graham, N. Agrawal, S. Roth (1988)
PREVENTION OF NSAID-INDUCED GASTRIC ULCER WITH MISOPROSTOL: MULTICENTRE, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIALThe Lancet, 332
Isal JP Bigard MA (1988)
Complete prevention by omeprazole of aspirin induced gastric lesions in healthy subjectsGut., 29
Stromatt SC Graham DY (1991)
Prevention of duodenal ulcer in arthritics who are chronic NSAID users: a multicenter trial of the role of misoprostolGastroenterology., 100
J. Fries, S. Miller, P. Spitz, Catherine Williams, H. Hubert, D. Bloch (1989)
Toward an epidemiology of gastropathy associated with nonsteroidal antiinflammatory drug use.Gastroenterology, 96 2 Pt 2 Suppl
Y. Pirson, C. Strihou (1986)
Renal side effects of nonsteroidal antiinflammatory drugs: clinical relevance.American journal of kidney diseases : the official journal of the National Kidney Foundation, 8 5
McMahon F Ryan JR (1986)
Effects of salsalate, aspirin, and naproxen on plasma renin activity and platelet thromboxane (TxB2) synthesisArthritis Rheum., 29
P. Abraham, M. Stillman (1987)
Salsalate exacerbation of chronic renal insufficiency. Relation to inhibition of prostaglandin synthesis.Archives of internal medicine, 147 9
U. Svendsen, J. Gerstoft, T. Hansen, P. Christensen, I. Lorenzen (1984)
The renal excretion of prostaglandins and changes in plasma renin during treatment with either sulindac or naproxen in patients with rheumatoid arthritis and thiazide treated heart failure.The Journal of rheumatology, 11 6
R. Bunning, W. Barth (1982)
Sulindac. A potentially renal-sparing nonsteroidal anti-inflammatory drug.JAMA, 248 21
Faulkner G Somerville K (1986)
Non-steroidal anti-inflammatory drugs and bleeding gastric ulcerLancet., 1
Abramowicz M (1989)
MisoprostolMed Lett., 31
Roger Oldham (1980)
Ketotifen in adult asthma.British Medical Journal, 280
C. Hawkey (1990)
Non-steroidal anti-inflammatory drugs and peptic ulcers.British Medical Journal, 300
K. Berg, T. Talseth (1985)
Acute renal effects of sulindac and indomethacin in chronic renal failureClinical Pharmacology & Therapeutics, 37
Walker JJ Brooks PM (1975)
Indomethacin-aspirin interactions: a clinical appraisalBMJ., 3
Saggioro A Agrawal NM (1991)
Treatment and prevention of NSAID induced gastroduodenal damageJ Rheumatol., 18
J. Mcintosh, C. Fung, G. Berry, D. Piper (1988)
Smoking, nonsteroidal anti-inflammatory drugs, and acetaminophen in gastric ulcer. A study of associations and of the effects of previous diagnosis on exposure patterns.American journal of epidemiology, 128 4
A. Hillman, B. Bloom (1989)
Economic effects of prophylactic use of misoprostol to prevent gastric ulcer in patients taking nonsteroidal anti-inflammatory drugs.Archives of internal medicine, 149 9
N. Agrawal, A. Saggioro (1991)
Treatment and prevention of NSAID induced gastroduodenal mucosal damage.The Journal of rheumatology. Supplement, 28
E. Gudmand-Høyer, H. Fenger, P. Kern-Hansen, P. Madsen (1987)
Sucrase deficiency in Greenland. Incidence and genetic aspects.Scandinavian journal of gastroenterology, 22 1
Rack MF Lanza FL (1985)
Reduction in gastric mucosal hemorrhage and ulceration with chronic high-level dosing of entericcoated aspirin granules two and four times a dayDig Dis Sci., 30
J. Mcintosh, K. Byth, D. Piper (1985)
Environmental factors in aetiology of chronic gastric ulcer: a case control study of exposure variables before the first symptoms.Gut, 26
Banerjee AK Clinch D (1987)
Non-steroidal anti-inflammatory drugs and peptic ulcerationJ R Coll Physicians., 21
D. Collier, J. Pain (1985)
Non-steroidal anti-inflammatory drugs and peptic ulcer perforation.Gut, 26
A. Soll, W. Weinstein, J. Kurata, D. McCarthy (1991)
Nonsteroidal anti-inflammatory drugs and peptic ulcer disease.Annals of internal medicine, 114 4
F. Lanza, G. Royer, R. Nelson (1980)
Endoscopic evaluation of the effects of aspirin, buffered aspirin, and enteric-coated aspirin on gastric and duodenal mucosa.The New England journal of medicine, 303 3
Calzada R Jaszewski R (1989)
Persistence of gastric ulcers caused by plain aspirin or nonsteroidal antiinflammatory agents in patients treated with a combination of cimetidine, antacids, and enteric coated aspirinDig Dis Sci., 34
Jeffrey Carson, Brian Strom, M. Morse, Suzanne West, Keith Soper, P. Stolley, Judith Jones, Judith Jones (1987)
The relative gastrointestinal toxicity of the nonsteroidal anti-inflammatory drugs.Archives of internal medicine, 147 6
S. Roth (1988)
Nonsteroidal anti-inflammatory drugs: gastropathy, deaths, and medical practice.Annals of internal medicine, 109 5
Karlin DA Lanza FL (1987)
A double-blind placebo controlled endoscopic study comparing the mucosal injury seen with orally and parenterally administerd nonsteroidal analgesic ketorolac tromethamine at therapeutic and subtherapeutic dosesAm J Gastroenterol., 82
Ward JR (1985)
Rheumatic Therapeutics
C. Armstrong, A. Blower (1987)
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M. Levy, Donald Miller, D. Kaufman, V. Siskind, P. Schwingl, L. Rosenberg, B. Strom, S. Shapiro (1988)
Major upper gastrointestinal tract bleeding. Relation to the use of aspirin and other nonnarcotic analgesics.Archives of internal medicine, 148 2
S. Jick, A. Walker, D. Perera, H. Jick (1987)
NON-STEROIDAL ANTI-INFLAMMATORY DRUGS AND HOSPITAL ADMISSION FOR PERFORATED PEPTIC ULCERThe Lancet, 330
E. Semble, W. Wu (1987)
Antiinflammatory drugs and gastric mucosal damage.Seminars in arthritis and rheumatism, 16 4
A. Rossi, J. Hsu, G. Faich (1987)
Ulcerogenicity of piroxicam: an analysis of spontaneously reported data.British Medical Journal (Clinical research ed.), 294
Smith JL Graham DY (1988)
Gastric adaptation occurs with aspirin administration in manDig Dis Sci., 28
J. Edelson, Anna Tosteson, Paul Sax (1990)
Cost-effectiveness of misoprostol for prophylaxis against nonsteroidal anti-inflammatory drug-induced gastrointestinal tract bleeding.JAMA, 264 1
E. Ayoub, E. Kaplan (1991)
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N. Agrawal, S. Roth, D. Graham, Richard White, B. Germain, Jefffrey Brown, S. Stromatt (1991)
Misoprostol Compared with Sucralfate in the Prevention of Nonsteroidal Anti-inflammatory Drug-induced Gastric Ulcer: A Randomized, Controlled TrialAnnals of Internal Medicine, 115
G. Ciabattoni, G. Cinotti, A. Pierucci, Simonetti Bm, Massimo Manzi, F. Pugliese, P. Barsotti, G. Pecci, F. Taggi, C. Patrono (1984)
Effects of sulindac and ibuprofen in patients with chronic glomerular disease. Evidence for the dependence of renal function on prostacyclin.The New England journal of medicine, 310 5
M. Griffin, W. Ray, W. Schaffner (1988)
Nonsteroidal anti-inflammatory drug use and death from peptic ulcer in elderly persons.Annals of internal medicine, 109 5
D. Clive, J. Stoff (1984)
Renal syndromes associated with nonsteroidal antiinflammatory drugs.The New England journal of medicine, 310 9
Lee Simon, John Mills (1980)
Nonsteroidal Antiinflammatory DrugsThe New England Journal of Medicine, 302
Hawkey CJ (1990)
Non-steroidal anti-inflammatory drugs and peptic ulcers: facts and figures multiply, but do they add up?BMJ., 300
J. Kurata, David Abbey (1990)
The effect of chronic aspirin use on duodenal and gastric ulcer hospitalizations.Journal of clinical gastroenterology, 12 3
Feld AD Silverstein FE (1981)
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Bagby GF O'Brien WM (1985)
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Brandt KD Bradley JD (1991)
Comparison of an antiinflammatory dose of ibuprofen, and acetaminophen in the treatment of patients with osteoarthritis of the kneeN Engl J Med., 325
Simon Ls, Mills Ja (1980)
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Stillman Mt, Schlesinger Pa (1990)
Nonsteroidal anti-inflammatory drug nephrotoxicity. Should we be concerned?JAMA Internal Medicine, 150
Anderson SA Brater DC (1986)
Effects of nonsteroidal anti-inflammatory drugs on renal function in patients with renal insufficiency and in cirrhoticsAm J Kidney Dis., 8
Roth Sh (1988)
NSAID and gastropathy: a rheumatologist's review.The Journal of Rheumatology, 15
Ward JR Clegg DO (1987)
Rheumatoid arthritis: using other NSAIDS when apirin failsJ Musculoskel Med., 4
M. Liang, P. Fortin (1991)
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S. Gabriel, L. Jaakkimainen, C. Bombardier (1991)
Risk for serious gastrointestinal complications related to use of nonsteroidal anti-inflammatory drugs. A meta-analysis.Annals of internal medicine, 115 10
R. Walt, R. Logan, B. Katschinski, J. Ashley, M. Langman (1986)
RISING FREQUENCY OF ULCER PERFORATION IN ELDERLY PEOPLE IN THE UNITED KINGDOMThe Lancet, 327
J. Duggan, A. Dobson, H. Johnson, P. Fahey (1986)
Peptic ulcer and non-steroidal anti-inflammatory agents.Gut, 27
J. Bradley, Kenneth Brandt, Kenneth Brandt, Barry Katz, L. Kalasinski, S. Ryan (1991)
Comparison of an antiinflammatory dose of ibuprofen, an analgesic dose of ibuprofen, and acetaminophen in the treatment of patients with osteoarthritis of the knee.The New England journal of medicine, 325 2
Schlesinger PA Stillman MT (1990)
Nonsteroidal anti-inflammatory drug nephrotoxicity: should we be concerned?Arch Intern Med., 150
W. Bartle, A. Gupta, J. Lazor (1986)
Nonsteroidal anti-inflammatory drugs and gastrointestinal bleeding. A case-control study.Archives of internal medicine, 146 12
J. Fries (1991)
NSAID gastropathy: the second most deadly rheumatic disease? Epidemiology and risk appraisal.The Journal of rheumatology. Supplement, 28
Cinotti GA Ciabattoni G (1984)
Effects of sulindac and ibuprofen in patients with chronic glomerular diseaseN Engl J Med., 310
Dorothy Estes, Karen Kaplan (1980)
Lack of platelet effect with the aspirin analog, salsalate.Arthritis and rheumatism, 23 11
J. Hoftiezer, Marlyn Burks, G. Silvoso, K. Ivey (1980)
COMPARISON OF THE EFFECTS OF REGULAR AND ENTERIC-COATED ASPIRIN ON GASTRODUODENAL MUCOSA OF MANThe Lancet, 316
C. Johansson (1987)
Ulcerogenic drugs and antiulcer compounds: effects on gastroduodenal mucosa.Scandinavian journal of gastroenterology. Supplement, 128
ed Cardinale VA (1990)
Drug Topics Red Book
H. Guess, Robert West, L. Strand, D. Helston, E. Lydick, U. Bergman, K. Wolski (1988)
Fatal upper gastrointestinal hemorrhage or perforation among users and nonusers of nonsteroidal anti-inflammatory drugs in Saskatchewan, Canada 1983.Journal of clinical epidemiology, 41 1
Smith DL Levy RA (1989)
Clinical differences among non-steroidal anti-inflammatory drugs: implications for therapeutic substitution in ambulatory patientsDICP., 23
G. Silvoso, K. Ivey, J. Butt, O. Lockard, S. Holt, C. Sisk, W. Baskin, P. Mackercher, J. Hewett (1979)
Incidence of gastric lesions in patients with rheumatic disease on chronic aspirin therapy.Annals of internal medicine, 91 4
Polisson RP (1987)
Selecting a NSAID for elderly patientsHosp Ther., 12
Abstract Salicylates and nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for the treatment of painful disorders. This article reviews the efficacy, side effects, and costs of these agents and proposes a practical approach to using them in a cost-effective manner. Although there may be some differences in efficacy among available drugs, these do not appear sufficient to justify using the more expensive agents in most cases. Adverse effects, especially gastrointestinal (GI), add to the cost of using these drugs. Aspirin and all nonsalicylate NSAIDs share a risk of causing gastric ulcer, upper GI bleeding, and GI perforation. Prostaglandin inhibition by these agents may lead to reduced glomerular filtration rate and renal failure. There may be modest differences in GI and renal risks with the different agents, but these are minimal. Prophylaxis against gastric ulceration with anti-ulcer drugs has been recommended, and one agent, misoprostol, is approved for use in the United States for this purpose. Whether use of prophylaxis will increase or decrease the costs associated with NSAID therapy remains to be determined. Nonacetylated salicylates may cause less GI adverse effects and may be somewhat "renal sparing." Strategies that would reduce the cost of care for painful musculoskeletal disorders without compromising quality of care include using acetaminophen instead of an NSAID for noninflammatory disorders, trying nonacetylated salicylates as less expensive and safer alternatives to NSAIDs, using one agent at a time, allowing sufficient time to evaluate the therapeutic effect before changing agents, returning to the least expensive and/or safest drug if a trial of several in succession fails to find one that is clearly better, and reserving prophylactic use of antiulcer agents for patients who are at especially high risk and for whom anti-inflammatory effects are clearly needed. (Arch Intern Med. 1992;152:1995-2002) References 1. McDuffie FC. The morbidity impact of rheumatoid arthritis on society . Am J Med. 1985;78:1-5.Crossref 2. Committee on Safety of Medicines. Non-steroidal anti-inflammatory drugs and serious gastrointestinal adverse reactions, I . BMJ. 1986;292:614.Crossref 3. 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Archives of Internal Medicine – American Medical Association
Published: Oct 1, 1992
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