Nonsteroidal anti-inflammatory drugs of the adverse reactions

In addition, doctors are more concerned about the cardiovascular disease risk of NSAIDs, including myocardial infarction and stroke.

A study in 2000 compared the gastrointestinal side effects of the COX-2 inhibitor rofecoxib and the traditional NSAID naproxen. The results suggested that the gastrointestinal side effects of rofecoxib were significantly reduced, but the study unexpectedly found that rofecoxib Coxib has an increased risk of heart disease and stroke. This is related to the selective inhibition of COX-2 inhibitors, which makes the dynamic balance of prostaglandins in blood vessels and thromboxane in platelets imbalance, so that thrombosis is easy to form. 

Subsequent studies suggest that compared with placebo, both traditional NSAIDs and selective COX-2 inhibitors may increase the risk of adverse cardiovascular events. Therefore, for the elderly and patients with cardiovascular risk factors, NSAIDs should be used when using NSAIDs. Good risk assessment and monitoring. Individual studies suggest that the use of naproxen has a lower cardiovascular risk than other NSAIDs, but there is currently no consensus.

In the past, it was believed that the synthesis of prostaglandin in the kidney was only related to COX-1, so it was thought that COX-2 inhibitors would be better in terms of adverse renal reactions. In fact, with the deepening of understanding, it was discovered that the kidney also expresses COX-2. Therefore, if long-term large-scale use, whether traditional NSAIDs or COX-2 inhibitors, there is a potential risk of kidney damage.

The risk of liver damage in NSAIDs is not high, but liver enzymes may increase during the use of individual drugs, such as nimesulide. In recent years, with the deepening of the understanding of this aspect, the clinical use of nimesulide has been gradually reduced.

How to reduce the incidence of side effects of NSAIDs?

① In clinical application, the combined use of two or more NSAIDs drugs should be avoided.

②For those with gastrointestinal discomfort or peptic ulcer, COX-2 inhibitors are preferred over traditional NSAIDs, and gastric medicine is added when necessary.

③For patients who have only high cardiovascular risk and no other risk factors, consider using naproxen first.

④ While applying NSAIDs treatment, if the situation permits, pay attention to avoid the use of diuretics, ACEI/ARB antihypertensive drugs and other drugs that may affect renal perfusion at the same time.

⑤ NSAIDs have a capping effect, and overdose medication should be avoided. Overdose will not increase the efficacy, but the side effects will increase significantly.

⑥ Necessary hematology and renal function monitoring should be carried out on a regular basis under the guidance of a doctor.

⑦ If the condition permits, avoid taking large amounts of medicine for a long time. For example, the treatment of gout patients should be based on the control of blood uric acid to reduce gout attacks, rather than long-term dependence on NSAIDs. For another example, the treatment of rheumatoid arthritis and ankylosing spondylitis should be based on the control of the disease by anti-rheumatic drugs and/or biological agents, and reduce dependence on NSAIDs. For example, in the treatment of osteoarthritis, it is also possible to consider the use of disease-improving drugs and joint cavity injections.