What Is the Most Effective Therapy for Preventing NSAID-Induced Gastropathy?

Abstract

Nonsteroidal anti-inflammatory drug (NSAID)-induced gastrointestinal toxicity is associated with morbidity and mortality, and given the very wide use of NSAIDs, is problematic and costly to society. Several options are now available to minimize gastrointestinal toxicity from NSAIDs. These options include the proton pump inhibitors, misoprostil, double-dose H₂-receptor blockers and the COX-2 selective NSAIDs. No head-to-head clinical trials have compared these options. The effectiveness of these strategies to minimize NSAID-induced gastrointestinal toxicity is summarized. In addition, their associated adverse effect profiles and costs are compared.

Key Words:

• NSAID
• nonsteroidal anti-inflammatory drug
• gastrointestinal toxicity
• treatment options
• misoprostil
• celecoxib
• rofecoxib
• omeprazole
• diclofenac
• proton pump inhibitors
• histamine 2 receptor antagonists
• prostaglandin

Additional information

Notes on contributors

Jane Chandramouli

Cherokee Layson-Wolf, PharmD, is Assistant Professor at the University of Maryland School of Pharmacy. At the time that this review was conducted, she was a Community Care Pharmacy Practice Resident at Virginia Commonwealth University.

Perry G. Fine, MD, is Professor of Anesthesiology, School of Medicine and Associate Medical Director, Pain Management Center at the University of Utah Health Sciences Center, Salt Lake City; and National Medical Director, VistaCare, based in Scottsdale, AZ. This commentary is based on an article in Dr. Fine's VistaCare Palliative Medicine Monitor.