title: [New non-steroidal anti-inflammatory drugs (NSAID's) with lesser side effects, and over-the-counter low-dose preparations].
abstract: Three recent developments with respect to therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) are the identification of two isoenzymes of cyclooxygenase (COX-1 and COX-2), the development of NO-NSAIDs, and the availability of low-dose over-the-counter (OTC) NSAIDs. COX-1 products mainly have a physiologically regulating and protective effect, while COX-2 products result in inflammation. There is initial enthousiasm for selective COX-2 antagonists with respect to the gastrointestinal adverse reactions. However, recent animal data indicate that high doses of COX-2 antagonists are usually necessary to obtain an adequate anti-inflammatory effect, which doses also antagonize COX-1. The development of NO-NSAIDs is also promising. These drugs release NO which may protect the local microvasculature. However, there is as yet hardly any practical experience with these drugs. OTC use of low-dose NSAIDs is increasing. As far as is now known, the overall risk is low because of the lower dose used. Nevertheless, the usual contra-indications should be kept in mind, such as age over 60 years, a prior history of peptic ulcers, co-morbidity, and concurrent treatment with other NSAIDs or anticoagulants.
authors.affiliation: Academisch Medisch Centrum, afd. Gastro-enterologie-Hepatologie, Amsterdam.
authors.forename: G N
authors.initials: GN
authors.lastname: Tytgat
mesh_terms: D000368:Aged; D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000494:pharmacology*; D002196:Capillaries / Q000187:drug effects; D000075202:Contraindications; D016861:Cyclooxygenase Inhibitors / Q000145:classification / Q000494:pharmacology*; D004064:Digestive System / Q000187:drug effects*; D004347:Drug Interactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020030:Nitric Oxide Donors / Q000494:pharmacology*; D004366:Nonprescription Drugs / Q000494:pharmacology*; D018570:Risk Assessment
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors; D020030:Nitric Oxide Donors; D004366:Nonprescription Drugs
vernacular_title: Nieuwe niet-steroïde anti-inflammatoire medicijnen (NSAID's) met minder bijwerkingen, en vrij verkrijgbare laaggedoseerde preparaten.