[Selective inhibitors of type 2 cyclooxygenase: less renal effects than the classical non-steroidal anti-inflammatory agents].
Prostaglandins play an important role in the regulation of renal hemodynamics and sodium excretion. Thus, the administration of non-steroidal anti-inflammatory drugs (NSAIDs) induces a renal vasoconstriction and sodium and potassium retention. In some high risk patients, this may lead to acute renal failure. The anti-inflammatory and renal effects of conventional NSAIDs are mediated by the non-selective inhibition of two cyclo-oxygenases, COX-1 and COX-2. Recently, highly selective COX-2 inhibitors have been developed such as celecoxib (Celebrex) and rofecoxib (Vioxx). These drugs were designed to preserve the analgesic and anti-inflammatory properties of NSAIDs while reducing their gastro-intestinal and renal side effects. Selective COX-2 inhibitors have indeed less gastro-intestinal side-effects. However, their renal profile is comparable to that of non-selective inhibitors as they induce a decrease in glomerular filtration rate and a sodium and potassium retention. Thus, despite the good gastro-intestinal safety profile of selective COX-2, one should be careful with the use of these agents in high risk patients as they may induce similar renal complications as non-selective NSAIDs.
Chiolero
A
A
Division d'hypertension et de médecine vasculaire, Centre hospitalier universitaire vaudois, Lausanne.
Würzner
G
G
Burnier
M
M
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D051546:Cyclooxygenase 2; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006801:Humans; D007527:Isoenzymes / Q000032:analysis / Q000037:antagonists & inhibitors*; D007668:Kidney / Q000187:drug effects / Q000201:enzymology / Q000503:physiopathology; D007674:Kidney Diseases / Q000139:chemically induced* / Q000517:prevention & control; D008565:Membrane Proteins; D011451:Prostaglandin-Endoperoxide Synthases / Q000032:analysis; D011453:Prostaglandins / Q000502:physiology; D012083:Renin / Q000378:metabolism
D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors; D007527:Isoenzymes; D008565:Membrane Proteins; D011453:Prostaglandins; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases; D012083:Renin
Les inhibiteurs sélectifs de la cyclooxygénase de type 2: moins d'effets rénaux que les anti-inflammatoires non stéroïdiens classiques?