Evolution to Low-Dose NSAID Therapy

Abstract

All NSAIDs are to varying degrees associated with gastrointestinal, cardiovascular and renal adverse effects (AEs). Differences in selectivity for inhibition of the COX isozymes (COX-1/COX-2) have been used as an indicator of the likelihood of experiencing an AE, but the measure of ‘selectivity’ commonly used is less than desirable, and selectivity has not yielded unequivocal superior safety. Recent guidelines recommend that NSAIDs be used at the lowest effective dose and for the shortest period of time. In response, ‘low-dose’ NSAID formulations have been developed. Such formulations may help by reducing overall systemic exposure, thereby reducing the frequency or severity of AEs. It seems timely to review the need, rationale and application of such an approach.

KEYWORDS:

• acute pain
• adverse effects
• chronic pain
• NSAID

Financial & competing interests disclosure.

At times, JV Pergolizzi, RB Raffa, S Nalamachu and R Taylor act as consultants, researchers and/or lecturers for various pharmaceutical companies but receive no financial support related to sale of any product. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

This paper was prepared with medical writing services provided by Jo Ann LeQuang of LeQ Medical in Angleton, Texas. Funding for manuscript preparation was provided by Iroko Pharmaceuticals.