The Effect of Nonsteroidal Antiinflammatory Drugs on Electrolyte Homeostasis and Blood Pressure in Young and Elderly Persons With and Without Renal Insufficiency

BACKGROUND: Nonsteroidal antiinflammatory drugs have been associated with exacerbation of hypertension. Differing effects on blood pressure (BP) have been reported in studies comparing celecoxib and rofecoxib. Concern regarding the cardiovascular safety of the cyclooxygenase-2 (COX-2) inhibitor class has intensified since the removal of rofecoxib from the market. OBJECTIVE: To evaluate the effect of a formulary change from celecoxib to rofecoxib on the BP of Native American patients at an Indian Health Service medical center. METHODS: Medical records of patients switched from celecoxib to rofecoxib were retrospectively reviewed. BP during the respective treatments was compared as follows: measurements recorded while taking celecoxib within 6 months before the index date and while taking rofecoxib from 1 week after the index date through 6 months of treatment were averaged. Differences in systolic and diastolic BP before and after the therapy change were evaluated using a paired Student's t-test. Subgroup analysis was performed for patients with preexisting hypertension. RESULTS: During rofecoxib therapy, the mean systolic BP was 2.9 mm Hg higher (p = 0.015) and the mean diastolic BP was 1.5 mm Hg higher (p = 0.042) than during celecoxib therapy. Among hypertensive patients, the respective mean systolic and diastolic BPs were 4.8 mm Hg (p = 0.009) and 2.0 mm Hg (p = 0.063) higher while taking rofecoxib. CONCLUSIONS: Switching patients from celecoxib to rofecoxib resulted in an increase in BP, with a larger difference observed in patients with hypertension. Future studies assessing the cardiovascular safety of currently marketed and investigational COX-2 inhibitors should evaluate the possible contribution of BP effects of these agents to overall risk.

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Do the Blood Pressure Effects of Nonsteroidal Antiinflammatory Drugs Influence Cardiovascular Morbidity and Mortality?

Current Hypertension Reports ◽

10.1007/s11906-010-0120-8 ◽

2010 ◽

Vol 12 (4) ◽

pp. 258-266 ◽

Cited By ~ 9

Author(s):

William J. Elliott

Keyword(s):

Blood Pressure ◽

Nonsteroidal Antiinflammatory Drugs ◽

Cardiovascular Morbidity ◽

Pressure Effects ◽

Morbidity And Mortality ◽

Antiinflammatory Drugs ◽

Cardiovascular Morbidity And Mortality ◽

Blood Pressure Effects

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Effects of Nonsteroidal Antiinflammatory Drugs on Renal Function in Patients With Renal Insufficiency and in Cirrhotics

American Journal of Kidney Diseases ◽

10.1016/s0272-6386(86)80110-x ◽

1986 ◽

Vol 8 (5) ◽

pp. 351-355 ◽

Cited By ~ 18

Author(s):

D. Craig Brater ◽

Shirley A. Anderson ◽

Debbie Brown-Cartwright ◽

Robert D. Toto

Keyword(s):

Renal Function ◽

Renal Insufficiency ◽

Nonsteroidal Antiinflammatory Drugs ◽

Antiinflammatory Drugs

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A Simple Test for the Most Common Cause or Aggravating Factor of the Neck, Shoulder, or Upper Extremity Pain

Journal of Orthopedic and Spine Trauma ◽

10.18502/jost.v5i4.4377 ◽

2020 ◽

Author(s):

Rohollah Khajeh ◽

Yousef Fallah

Keyword(s):

Blood Pressure ◽

Upper Extremity ◽

Older Patients ◽

Laboratory Tests ◽

Correct Diagnosis ◽

Age Groups ◽

Symptomatic Treatment ◽

Nonsteroidal Antiinflammatory Drugs ◽

Antiinflammatory Drugs ◽

Common Cause

Background: Shoulder pain and neck pain affect respectively 25% and 43% of the population. The aim of this clinical study is to assess the proportion, correct diagnosis, and treatment of hypertension (HTN) in patients with pain in the neck, shoulder, and upper extremity. Methods: 300 patients with complaints of neck, shoulder, or upper extremity pain without trauma or infection were studied from January 2015 to December 2017. After taking the history and examination, the blood pressure of these patients was recorded. Laboratory tests, x-ray, and magnetic resonance imaging (MRI) of the neck and affected shoulder joint were requested. Antihypertensive and symptomatic treatments were prescribed for patients with HTN. In the next visits, new history and examination, including the range of motion (ROM) of neck, shoulder, and upper extremity, blood pressure, and the results of laboratory tests, and images were checked. The final data were analyzed using chi-square test in SPSS software. Results: The Prevalence of HTN in patients in the age groups of 20-30, 31-60, and above 60 years were 21%, 44%, and 56 %, respectively. Neck, shoulder, and upper extremity pain and motion improved significantly after antihypertensive and symptomatic treatment in patients with HTN. Conclusion: HTN is the most common cause of neck, shoulder, and upper extremity pain in the adults and older patients referring to a physician. Thus, checking blood pressure by a physician or specialist is recommended for adults or older patients with neck, shoulder, or upper extremity pain. Antihypertensive and symptomatic treatments must be prescribed for nonsteroidal antiinflammatory drugs (NSAIDs), and acetaminophen-codeine and corticosteroids should be prohibited for the patients with HTN.

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Renal Insufficiency Associated with Intramuscular Administration of Ketorolac Tromethamine

Annals of Pharmacotherapy ◽

10.1177/106002809302700908 ◽

1993 ◽

Vol 27 (9) ◽

pp. 1055-1057 ◽

Cited By ~ 19

Author(s):

Robin L. Corelli ◽

Kristin R. Gericke

Keyword(s):

Renal Insufficiency ◽

Renal Toxicity ◽

Adverse Drug Reaction Reporting ◽

Nonsteroidal Antiinflammatory Drugs ◽

Ketorolac Tromethamine ◽

Antiinflammatory Drugs ◽

Narcotic Analgesics ◽

Term Administration ◽

The Mean ◽

Peak Value

OBJECTIVE: To evaluate reports of renal toxicity associated with intramuscular ketorolac tromethamine. Medical charts were reviewed for all cases of renal toxicity associated with ketorolac therapy. METHODS: Patients with possible ketorolac-associated nephrotoxicity were identified through our institution's adverse drug reaction reporting program. Patients were included in this report if: (1) renal insufficiency was temporally related to ketorolac administration; (2) resolution of renal insufficiency occurred after discontinuation of ketorolac; and (3) no other causes of renal insufficiency, including other medications, could be identified. RESULTS: Six patients had renal insufficiency secondary to ketorolac administration. The mean age of the patients was 58 years and cardiovascular disease was present in five. Serum creatinine values increased from a mean of 106 ± 26 μmol/L (1.2 ± 0.3 mg/dL) to a mean peak value of 256 ± 195 μmol/L (2.9 ± 2.2 mg/dL). Recovery of renal function was observed after a mean of 2.3 ± 0.5 days. CONCLUSIONS: Short-term administration of ketorolac can be associated with reversible oliguric renal insufficiency. Indiscriminate use of ketorolac for pain management in place of narcotic analgesics should be avoided, especially in patients at high risk for toxicity induced by nonsteroidal antiinflammatory drugs.

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