scholarly journals Adverse Effects of Topical Nonsteroidal Antiinflammatory Drugs in Older Adults with Osteoarthritis: A Systematic Literature Review

2010 ◽  
Vol 37 (6) ◽  
pp. 1236-1243 ◽  
Author(s):  
UNA E. MAKRIS ◽  
MINNA J. KOHLER ◽  
LIANA FRAENKEL
Keyword(s):  
Older Adults ◽  
Adverse Effects ◽  
Case Reports ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Withdrawal Rate ◽  
Treatment Modalities ◽  
Application Site ◽  
Topical Nsaid ◽  
Antiinflammatory Drugs ◽  
Oral Nsaid

Objective.To systematically review the literature on reported adverse effects (AE) associated with use of topical nonsteroidal antiinflammatory drugs (NSAID) in older adults with osteoarthritis (OA).Methods.A systematic search of Medline (1950 to November 2009), Scopus, Embase, Web of Science, Cochrane databases, Dissertation and American College of Rheumatology meeting abstracts was performed to identify original randomized controlled trials, case reports, observational studies, editorials, or dissertations reporting AE from topical NSAID in older adults with OA. Information was sought on study and participant characteristics, detailed recording of application site, and systemic AE as well as withdrawals due to AE.Results.The initial search yielded 953 articles of which 19 met eligibility criteria. Subjects receiving topical NSAID reported up to 39.3% application site AE, and up to 17.5% systemic AE. Five cases of warfarin potentiation with topical agents were reported, 1 resulting in gastrointestinal bleeding. In formal trials, the withdrawal rate from AE ranged from 0 to 21% in the topical agents, 0 to 25% in the oral NSAID, and 0 to 16% in the placebo group.Conclusion.Although topical NSAID are safer than oral NSAID (fewer severe gastrointestinal AE), a substantial proportion of older adults report systemic AE with topical agents. The withdrawal rate due to AE with topical agents is comparable to that of oral NSAID. Given the safety profile and withdrawal rates described in this study, further data are needed to determine the incremental benefits of topical NSAID compared to other treatment modalities in older adults with OA.

Gender Differences in NSAID Use among Older Adults with Osteoarthritis

2003 ◽  
Vol 37 (11) ◽  
pp. 1566-1571 ◽  
Author(s):  
Kelli L Dominick ◽  
Frank M Ahern ◽  
Carol H Gold ◽  
Debra A Heller
Keyword(s):  
Older Adults ◽  
Gender Differences ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Antiinflammatory Drugs ◽  
Related Quality ◽  
Health Related ◽  
Nsaid Prescription ◽  
Prescription Drug Plan ◽  
Gender Variations

BACKGROUND: Nonsteroidal antiinflammatory drugs (NSAIDs) are the most commonly prescribed medications for the treatment of osteoarthritis (OA). Little is known about whether there are important gender differences in NSAID use among patients with OA. OBJECTIVE: To examine gender differences in patterns of NSAID use among older adults (≥65 y) with OA. METHODS: Subjects (n = 11 298) were members of a statewide prescription drug plan who responded to a health-related quality-of-life (HRQOL) survey in 1997 and had a physician diagnosis of OA. Gender differences in patterns of NSAID use were examined over a 2-year period. RESULTS: Approximately one-third of the participants filled at least 1 NSAID prescription during the study. Women were significantly more likely to be prescribed an NSAID than men (37% vs. 30%), had a greater total days' supply of NSAIDs, and were more frequently prescribed NSAIDs with greater degrees of cyclooxygenase-2 selectivity. These gender differences persisted in statistical analyses controlling for demographic factors, HRQOL, and gastrointestinal (GI) risk factors. CONCLUSIONS: Results of this study showed significant gender differences in patterns of NSAID use, and these differences were independent of the risk for GI adverse effects and self-reported symptoms. Further research is needed to examine reasons for these gender variations, as well as their impact on the quality of symptom management.

Methotrexate and Nonsteroidal Antiinflammatory Drug Interactions

1992 ◽  
Vol 26 (2) ◽  
pp. 234-237 ◽  
Author(s):  
Maureen L. Frenia ◽  
Kimberly S. Long ◽  
Edward A. Hartshorn
Keyword(s):  
Case Reports ◽  
Clinical Manifestations ◽  
Hepatic Metabolism ◽  
Antiinflammatory Drug ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Nonsteroidal Antiinflammatory Drug ◽  
Pharmacokinetic Studies ◽  
Hematologic Toxicity ◽  
Antiinflammatory Drugs ◽  
Clinically Significant

OBJECTIVE: To determine if the coadministration of methotrexate (MTX) and nonsteroidal antiinflammatory drugs (NSAIDs) results in a clinically significant drug interaction. DATA SOURCES: A case report of hematologic toxicity following the administration of MTX and flurbiprofen at our institution is presented. Six previously published case reports and five pharmacokinetic studies regarding MTX and NSAID interactions are available to assist in the evaluation of this potential interaction. DATA SYNTHESIS: Cases of various clinical manifestations during concomitant MTX and NSAID administration, including acute renal failure and pancytopenia, have been reported. The exact mechanism of the interaction has not been fully elucidated. Suggested theories to explain the mechanism of MTX toxicity include reduction in MTX clearance secondary to renal capillary constriction induced by NSAIDs, displacement of MTX or its metabolite from plasma proteins, competition between MTX and NSAIDs for renal tubular excretion, or impairment of hepatic metabolism of MTX by NSAIDs. Studies comparing MTX pharmacokinetics with or without concurrent NSAID therapy have not shown statistical differences in the parameters evaluated. However, one study did demonstrate differences in the pharmacokinetics of 7-hydroxymethotrexate, the active metabolite of MTX, when MTX was administered with aspirin. CONCLUSIONS: Although a clinically significant interaction does not occur in all patients, numerous case reports are available that demonstrate possible problems following the coadministration of MTX and NSAIDs. To date, the specific circumstances during which the reaction may occur have not been well defined.

Effects of Nonsteroidal Antiinflammatory Drugs on Patient-controlled Analgesia Morphine Side Effects

2005 ◽  
Vol 102 (6) ◽  
pp. 1249-1260 ◽  
Author(s):  
Emmanuel Marret ◽  
Okba Kurdi ◽  
Paul Zufferey ◽  
Francis Bonnet ◽  
David C. Warltier
Keyword(s):  
Adverse Effects ◽  
Meta Analysis ◽  
Postoperative Nausea And Vomiting ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Nausea And Vomiting ◽  
Morphine Consumption ◽  
Patient Controlled Analgesia ◽  
Antiinflammatory Drugs ◽  
Double Blind ◽  
Sparing Effect

Nonsteroidal antiinflammatory drugs (NSAIDs) are commonly combined with intravenous morphine patient-controlled analgesia to relieve postoperative pain. NSAIDs have a documented 30-50% sparing effect on morphine consumption. However, most of the studies have not demonstrated a decrease in morphine adverse effects. A meta-analysis of randomized controlled trials was performed to evaluate the risk of morphine adverse effects in patients treated with NSAIDs. Twenty-two prospective, randomized, double-blind studies including 2,307 patients were selected. NSAIDs decreased significantly postoperative nausea and vomiting by 30%, nausea alone by 12%, vomiting alone by 32% and sedation by 29%. A regression analysis yielded findings indicating that morphine consumption was positively correlated with the incidence of nausea and vomiting. Pruritus, urinary retention, and respiratory depression were not significantly decreased by NSAIDs.

scholarly journals A nemszteroid gyulladáscsökkentő gyógyszerek kiválasztásának szempontjai a biztonságosság tükrében

2018 ◽  
Vol 159 (44) ◽  
pp. 1783-1788
Author(s):  
Szilvia Szamosi
Keyword(s):  
Adverse Effects ◽  
Adverse Events ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Antiinflammatory Drugs ◽  
Younger Patients ◽  
Professional Societies ◽  
Hungarian Society ◽  
History Of ◽  
Antiinflammatory Effects ◽  
Professional Guidelines

Abstract: Nonsteroidal antiinflammatory drugs are the most commonly used painkillers. Both analgetic and antiinflammatory effects of these medications are important in the treatment of rheumatic diseases. Despite their well-recognized efficacy, professional societies recommend using nonsteroidal antiinflammatory drugs with caution, balancing the various potential gastrointestinal, cardiovascular and renal adverse events. Clinicians should consider advanced age and history of concomitant diseases even in younger patients when considering treatment choice. As our Hungarian society is aging, prescribers must be aware of the basic pharmacodynamics and pharmacokinetics of nonsteroidal antiinflammatory drugs as well as drug interactions and potential adverse effects should be taken into consideration when using them according to the latest professional guidelines. Orv Hetil. 2018; 159(44): 1783–1788.

Carotidynia: An Unusual Pain in the Neck

1994 ◽  
Vol 110 (4) ◽  
pp. 387-390 ◽  
Author(s):  
C. Ron Cannon
Keyword(s):  
Head And Neck ◽  
Correct Diagnosis ◽  
Treatment Protocol ◽  
Neck Surgery ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Treatment Modalities ◽  
Laboratory Studies ◽  
Antiinflammatory Drugs ◽  
Temporomandibular Joint Syndrome ◽  
Physical Findings

Described by Fay in 1927, carotidynia has not received much attention in the otolaryngology-head and neck surgery literature. This unusual entity is characterized by ipsilateral neck pain in the region of the carotid artery near its bifurcation. The differential diagnosis is extensive and includes thyroiditis, migraine headache, aneurysm of the carotid system, temporomandibular joint syndrome, giant cell arteritis, and head and neck neoplasms. A correct diagnosis is usually achieved by careful review of the history and physical examination. Laboratory studies are obtained primarily to exclude other causes. Successful treatment is most often effected with the use of nonsteroidal antiinflammatory drugs, although other treatment modalities may be needed. A series of 25 patients treated during the past 10 years is presented. The symptoms, physical findings, appropriate laboratory studies, and a treatment protocol for this uncommon entity are detailed.

Glucosamine

1998 ◽  
Vol 32 (5) ◽  
pp. 574-579 ◽  
Author(s):  
Teresa Susanne Barclay ◽  
Candy Tsourounis ◽  
Gary M McCart
Keyword(s):  
Adverse Effects ◽  
Data Extraction ◽  
Critical Evaluation ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Control Group ◽  
Antiinflammatory Drugs ◽  
Skin Reactions ◽  
Medline Search ◽  
Degenerative Process ◽  
Gastrointestinal Problems

OBJECTIVE: To review the pharmacology and pharmacokinetics of glucosamine and critically evaluate currently available literature regarding its safety and efficacy. DATA SOURCE: A MEDLINE search was conducted between January 1965 and May 1997. Key words used in the search were osteoarthritis, osteoarthrosis, gonarthrosis, and glucosamine. In addition, references cited in articles obtained from the MEDLINE search were reviewed for additional literature. STUDY SELECTION AND DATA EXTRACTION: All articles were considered for inclusion in the review. Articles were excluded from critical evaluation for lack of randomization, lack of a control group, 30 or fewer study participants, inconsistent treatment regimen, incomplete dosing information, or incomplete reporting of results. DATA SYNTHESIS: Osteoarthritis affects approximately 12% of the US population; the incidence increases with increasing age. Currently used pharmacologic treatments, including acetaminophen and nonsteroidal antiinflammatory drugs, do not slow or reverse the degenerative process in osteoarthritis. Glucosamine has recently received a great deal of attention from the public as a potential treatment of osteoarthritis, prompting healthcare professionals to investigate its clinical usefulness and potential for adverse effects. The drug has been proposed to stop and possibly reverse the degenerative process in osteoarthritis. Following absorption of an oral dose, glucosamine is incorporated into plasma proteins during first-pass metabolism, resulting in 26% bioavailability. Unbound glucosamine is concentrated in the articular cartilage. Each of the three critically evaluated studies reported a decrease in the symptoms of osteoarthritis (e.g., decreased Lequesne index, decreased pain severity, increased range of motion) for the glucosamine group, which was greater than that obtained in the control group. Flaws in study design, however, prevent the use of these results in modifying current clinical practice. Reported short-term adverse effects include mild gastrointestinal problems, drowsiness, skin reactions, and headache. CONCLUSIONS: Improvement in the symptoms of osteoarthritis associated with the use of glucosamine has been observed in clinical trials; however, those trials have flaws in design and data analysis. Further research needs to be conducted before glucosamine can be recommended as a treatment for osteoarthritis.

scholarly journals A Novel Hope for Alopecia Totalis Patients: Case Report

2020 ◽  
Vol 3 (4) ◽  
pp. 150-153
Author(s):  
Manal Elsayed ◽  
Laila Al Otaibi ◽  
Nael Quraishy ◽  
Afzalhussein Yusufali
Keyword(s):  
Case Report ◽  
Adverse Effects ◽  
Case Reports ◽  
Autoimmune Disorder ◽  
Juvenile Chronic Arthritis ◽  
Janus Kinase ◽  
Treatment Modalities ◽  
Jak Inhibitors ◽  
Open Label ◽  
Hair Regrowth

Alopecia areata (AA) is a common autoimmune disorder causing nonscarring patchy hair loss. Alopecia totalis (AT) is a severe variant of AA. Although there are several available treatment modalities for AA, efficacy of most of them is not satisfactory in case of AT. Recently, several case reports and series and small open-label studies have shown efficacy of oral Janus kinase (JAK) inhibitors as treatment for AT. Tofacitinib is one of the JAK inhibitors, which is an approved drug for treatment of rheumatoid and psoriatic arthritis. In this case report, we have treated a 24-year-old girl who had juvenile chronic arthritis and developed AT. She was treated for 3 years with different modalities without satisfactorily results. We treated her with tofacitinib 5 mg orally twice a day and assessed its efficacy and adverse effects if any. We monitored scalp hair regrowth of the patient using the score of severity of alopecia tool. The patient tolerated the treatment well; hair regrowth started from the 4th week and full regrowth attained by the 9th month of the treatment. No serious adverse effects were noticed. Tofacitinib can potentially be considered as an effective and well-tolerated treatment for AT; however, larger studies are needed to address its long-term efficacy.

scholarly journals Adverse Effects of Nonsteroidal Antiinflammatory Drugs: An Update of Gastrointestinal, Cardiovascular and Renal Complications

2014 ◽  
Vol 16 (5) ◽  
pp. 821 ◽  
Author(s):  
Sam Harirforoosh ◽  
Waheed Asghar ◽  
Fakhreddin Jamali
Keyword(s):  
Side Effects ◽  
Adverse Effects ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Gi Tract ◽  
Antiinflammatory Drugs ◽  
Controlled Release Formulations ◽  
Gi Toxicity ◽  
Inflammatory Drugs ◽  
Cox 2

Non-steroidal anti-inflammatory drugs (NSAIDs) are used chronically to reduce pain and inflammation in patients with arthritic conditions, and also acutely as analgesics by many patients. Both therapeutic and adverse effects of NSAIDs are due to inhibition of cyclooxygenase (COX) enzyme. NSAIDs are classified as non-selective and COX-2-selective inhibitors (COXIBS) based on their extent of selectivity for COX inhibition. However, regardless of their COX selectivity, reports are still appearing on the GI side effect of NSAIDs particularly on the lower gastrointestinal (GI) tract and the harmful role of their controlled release formulations. In addition, previously unpublished data stored in the sponsor’s files, question the GI sparing properties of rofecoxib, a COXIB that has been withdrawn due to cardiovascular (CV) side effects. Presently, the major side effects of NSAIDs are the GI complications, renal disturbances and CV events. There is a tendency to believe that all NSAIDs are associated with renal and CV side effects, a belief that is not supported by solid evidence. Indeed, lower but still therapeutics doses of some NSAIDs may be cardioprotective. In this review, we briefly discuss the GI toxicity of the NSAIDs and assess their renal and CV adverse effects in more detail. This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.

scholarly journals Pentavalent Antimonials Combined with Other Therapeutic Alternatives for the Treatment of Cutaneous and Mucocutaneous Leishmaniasis: A Systematic Review

2018 ◽  
Vol 2018 ◽  
pp. 1-21 ◽  
Author(s):  
Taisa Rocha Navasconi Berbert ◽  
Tatiane França Perles de Mello ◽  
Priscila Wolf Nassif ◽  
Camila Alves Mota ◽  
Aline Verzignassi Silveira ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Adverse Effects ◽  
Case Reports ◽  
Combined Therapy ◽  
Alternative Therapy ◽  
Treatment Modalities ◽  
Sodium Stibogluconate ◽  
Mucocutaneous Leishmaniasis ◽  
First Choice

The first choice drugs for the treatment of cutaneous and mucocutaneous leishmaniasis are pentavalent antimonials, sodium stibogluconate, or meglumine antimoniate. However, the treatment with these drugs is expensive, can cause serious adverse effects, and is not always effective. The combination of two drugs by different routes or the combination of an alternative therapy with systemic therapy can increase the efficacy and decrease the collateral effects caused by the reference drugs. In this systematic review we investigated publications that described a combination of nonconventional treatment for cutaneous and mucocutaneous with pentavalent antimonials. A literature review was performed in the databases Web of Knowledge and PubMed in the period from 01st of December 2004 to 01st of June 2017, according to Prisma statement. Only clinical trials involving the treatment for cutaneous or mucocutaneous leishmaniasis, in English, and with available abstract were added. Other types of publications, such as reviews, case reports, comments to the editor, letters, interviews, guidelines, and errata, were excluded. Sixteen articles were selected and the pentavalent antimonials were administered in combination with pentoxifylline, granulocyte macrophage colony-stimulating factor, imiquimod, intralesional sodium stibogluconate, ketoconazole, silver-containing polyester dressing, lyophilized LEISH-F1 protein, cryotherapy, topical honey, and omeprazole. In general, the combined therapy resulted in high rates of clinical cure and when relapse or recurrence was reported, it was higher in the groups treated with pentavalent antimonials alone. The majority of the articles included in this review showed that cure rate ranged from 70 to 100% in patients treated with the combinations. Serious adverse effects were not observed in patients treated with drugs combination. The combination of other drugs or treatment modalities with pentavalent antimonials has proved to be effective for cutaneous and mucocutaneous leishmaniasis and for most seemed to be safe. However, new randomized, controlled, and multicentric clinical trials with more robust samples should be performed, especially the combination with immunomodulators.

Etoricoxib: A Highly Selective COX-2 Inhibitor

2005 ◽  
Vol 39 (5) ◽  
pp. 854-862 ◽  
Author(s):  
Shaunta‘ D Martina ◽  
Kimi S Vesta ◽  
Toni L Ripley
Keyword(s):  
Clinical Trials ◽  
Adverse Effects ◽  
Data Extraction ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Cochrane Library ◽  
Chronic Lower Back Pain ◽  
Acute Gout ◽  
Antiinflammatory Drugs ◽  
Dental Surgery ◽  
Cox 2

OBJECTIVE: To review the available literature evaluating the pharmacology, pharmacokinetics, clinical efficacy, and adverse effects of etoricoxib, a highly selective cyclooxygenase-2 (COX-2) inhibitor that is not currently approved for use in the US. DATA SOURCES: Literature retrieval was accessed through MEDLINE (1966–December 2004), Current Contents (1998–December 2004), and Cochrane Library (4th quarter 2004). References from retrieved articles, information from the manufacturer, and abstracts from the American College of Rheumatology and Annual European Congress of Rheumatology meetings were searched. STUDY SELECTION AND DATA EXTRACTION: All clinical trials published in English evaluating etoricoxib were included in this review. An abstract was excluded if it presented preliminary data from trials that are now published, analyzed data previously reported in a published clinical trial, or compared etoricoxib with placebo for an indication with published active-comparator controlled trials. DATA SYNTHESIS: Twelve clinical trials evaluating efficacy were reviewed. Efficacy for acute pain has been evaluated in acute gout, primary dysmenorrhea, and dental surgery and for chronic pain in rheumatoid arthritis, osteoarthritis, and chronic lower back pain. For safety, 3 clinical trials and 6 retrospective analyses of gastrointestinal, renovascular, or cardiovascular adverse effects were reviewed. CONCLUSIONS: Available studies demonstrate the efficacy of etoricoxib compared with nonsteroidal antiinflammatory drugs, but no published studies to date have compared etoricoxib with other selective COX-2 inhibitors. While these agents have demonstrated a significant reduction in gastrointestinal adverse effects, the cardiovascular adverse effects of selective COX-2 inhibition are not well defined. Further study is necessary to delineate the benefits and risks of etoricoxib compared with alternative treatment regimens.

Sign in / Sign up

Export Citation Format

Share Document