Indications

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

---

Contraindications

• Aspirin-Exacerbated Respiratory Disease (AERD) (see Aspirin-Exacerbated Respiratory Disease)
  • Due to COX-1 Inhibition
• Chronic Kidney Disease (CKD) (see Chronic Kidney Disease)
  • Due to Risk of Worsening Chronic Kidney Disease
• Chronic Liver Disease (see Cirrhosis )
  • Due to Frequent Co-Existing Chronic Kidney Disease (and Risk of Hepatorenal Syndrome) (see Hepatorenal Syndrome)
  • Due to Risk of Gastrointestinal Hemorrhage (see Gastrointestinal Hemorrhage)

---

Pharmacology

Nonsteroidal Anti-Inflammatory Drug (NSAID) (see Nonsteroidal Anti-Inflammatory Drug)

• xxx

Metabolism

• Hepatic: predominantly

---

Administration

• PO: xxx

---

Adverse Effects

Endocrinologic Adverse Effects

Drug-Induced Hyporeninemic Hypoaldosteronism (see 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)
  • Type 4 Renal Tubular Acidosis (RTA) (see Type 4 Renal Tubular Acidosis)

Gastrointestinal Adverse Effects

Acute Pancreatitis (see Acute Pancreatitis): definite association with acute pancreatitis

• xxx

Peptic Ulcer Disease (PUD) (see Peptic Ulcer Disease)

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

Hematologic Adverse Effects

• Aplastic Anemia (see Aplastic Anemia)

Pulmonary Adverse Effects

Aspirin-Intolerant Asthma (see Asthma)

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

Drug-Induced Pulmonary Eosinophilia (see Drug-Induced Pulmonary Eosinophilia)

• Associated Agents
  • Acetylsalicylic Acid (Aspirin) (see Acetylsalicylic Acid)
  • Diclofenac (Aclonac, Cataflam, Voltaren) (see Diclofenac)
  • Diflunisal (Dolobid)
  • Fenbufen
  • Fenoprofen (see Fenoprofen): case reports
  • Ibuprofen (Advil, Brufen, Motrin, Nurofen) (see Ibuprofen): case reports
  • Indomethacin (Indocin) (see Indomethacin)
  • Loxoprofen
  • Meloxicam (see Meloxicam)
  • Naproxen (Naprosyn, Aleve) (see Naproxen): appears to be more frequent with naproxen than other NSAID’s
  • Nimesulide
  • Phenylbutazone
  • Piroxicam (Feldene) (see Piroxicam)
  • Pranoprofen
  • Sulindac (Clinoril): case reports
  • Tenidap
  • Tiaprofenic Acid
  • Tolfenamic Acid
• Diagnosis
  • Lung Biopsy: poorly defined granulomas with infiltrating eosinophils
• Clinical
  • Cough
  • Dyspnea
  • Fever
  • Peripheral Eosinophilia
  • Pulmonary Infiltrates

Renal Adverse Effects

Acute Kidney Injury (see Acute Kidney Injury)

• xxx

Acute Interstitial Nephritis (see Acute Interstitial Nephritis)

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

Hyperkalemia (see Hyperkalemia)

• Mechanism: due to drug-induced hyporeninemic hypoaldosteronism

Increased Renal Sodium Reabsorption with Peripheral Edema

• Risk Factors
  • Advanced Age
  • Diabetes Mellitus (see Diabetes Mellitus)
  • Volume Contraction
    • Cirrhosis (see End-Stage Liver Disease)
    • Congestive Heart Failure (CHF) (see 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)
  • Hypertension (see Hypertension): usually moderate
  • Peripheral Edema (see Peripheral Edema)
  • Weight Gain (see Weight Gain)

Type 4 Renal Tubular Acidosis (RTA) (see 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)

---

References

• xxx