Indications

• Arthritis
  • Acute Gout (see Gout, [[Gout]])
  • Osteoarthritis (see Osteoarthritis, [[Osteoarthritis]])
  • Rheumatoid Arthritis
• Dysmenorrhea (see Dysmenorrhea, [[Dysmenorrhea]])
• Fever (see Fever, [[Fever]])
• Pain
  • Post-Operative Pain
  • Soft Tissue/Musculoskeletal Injury
• To Decrease the Risk of Malignancy
  • Breast Cancer (see Breast Cancer, [[Breast Cancer]])
  • Colorectal Cancer (see Colorectal Cancer, [[Colorectal Cancer]])
  • Prostate Cancer (see Prostate Cancer, [[Prostate Cancer]])

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Contraindications

• Chronic Kidney Disease (CKD) (see Chronic Kidney Disease, [[Chronic Kidney Disease]])
  • Due to Risk of Worsening Chronic Kidney Disease
• Chronic Liver Disease (see End-Stage Liver Disease, [[End-Stage Liver Disease]])
  • Due to Frequent Co-Existing Chronic Kidney Disease (and Risk of Hepatorenal Syndrome) (see Hepatorenal Syndrome, [[Hepatorenal Syndrome]])
  • Due to Risk of Gastrointestinal Hemorrhage (see Gastrointestinal Hemorrhage, [[Gastrointestinal Hemorrhage]])

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Pharmacology

• Non-Steroidal Anti-Inflammatory Drug (NSAID) (see Non-Steroidal Anti-Inflammatory Drug, [[Non-Steroidal Anti-Inflammatory Drug]])
  • Salicylate Class

Metabolism

• Hepatic: predominantly

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Administration

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Dose Adjustment

• Hepatic:
• Renal:

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Adverse Effects

Endocrinologic Adverse Effects

Drug-Induced Hyporeninemic Hypoaldosteronism (see Hypoaldosteronism, [[Hypoaldosteronism]])

• Physiology
  • Class effect, common to all NSAID’s
  • Dose-dependent COX-inhibition -> decreased renal prostaglandin synthesis -> results in drug-induced hyporeninemic hypoaldosteronism
• Clinical
  • Hyperkalemia (see Hyperkalemia, [[Hyperkalemia]])
  • Type 4 Renal Tubular Acidosis (RTA) (see Type 4 Renal Tubular Acidosis, [[Type 4 Renal Tubular Acidosis]])

Gastrointestinal Adverse Effects

Peptic Ulcer Disease (PUD) (see Peptic Ulcer Disease, [[Peptic Ulcer Disease]])

• Physiology: class effect, common to all NSAID’s

Pulmonary Adverse Effects

Aspirin-Intolerant Asthma (see Asthma, [[Asthma]])

• Physiology: class effect, common to multiple NSAID’s

Renal Adverse Effects

Acute Kidney Injury (see Acute Kidney Injury, [[Acute Kidney Injury]])

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Acute Interstitial Nephritis (see Acute Interstitial Nephritis, [[Acute Interstitial Nephritis]])

• Physiology: class effect, common to all NSAID’s

Hyperkalemia (see Hyperkalemia, [[Hyperkalemia]])

• Mechanism: due to drug-induced hyporeninemic hypoaldosteronism

Increased Renal Sodium Reabsorption with Peripheral Edema

• Risk Factors
  • Advanced Age
  • Diabetes Mellitus (see Diabetes Mellitus, [[Diabetes Mellitus]])
  • Volume Contraction
    • Cirrhosis (see End-Stage Liver Disease, [[End-Stage Liver Disease]])
    • Congestive Heart Failure (CHF) (see Congestive Heart Failure, [[Congestive Heart Failure]])
    • Decreased Sodium Intake
    • Diuretics
• Physiology: decreased PGE2 -> increased renal sodium reabsorption
  • Class Effect: common to all NSAID’s
  • Dose-Dependent Effect
• Clinical: typically occurs during the first week of therapy
  • Exacerbation of Congestive Heart Failure (see Congestive Heart Failure, [[Congestive Heart Failure]])
  • Hypertension (see Hypertension, [[Hypertension]]): usually moderate
  • Peripheral Edema (see Peripheral Edema, [[Peripheral Edema]])
  • Weight Gain (see Weight Gain, [[Weight Gain]])

Type 4 Renal Tubular Acidosis (RTA) (see Type 4 Renal Tubular Acidosis, [[Type 4 Renal Tubular Acidosis]])

• Physiology: due to NSAID-induced hyporeninemic hypoaldosteronism
• Clinical
  • Non-Anion Gap Metabolic Acidosis (NAGMA) (see Metabolic Acidosis-Normal Anion Gap, [[Metabolic Acidosis-Normal Anion Gap]])

Other Adverse Effects

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References

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