Choosing nonselective NSAIDs and selective COX-2 inhibitors in the elderly. A clinical use pathway.
The literature has well established that nonsteroidal anti-inflammatory drugs (NSAIDS) are very effective in treating pain and inflammation, but these drugs are associated with significant gastrointestinal (GI) toxicity. This is especially true in the elderly patient population. Selective cyclooxygenase-2 (COX-2) inhibitors (coxibs) were developed to decrease the incidence of GI adverse events. Nevertheless, recent concerns regarding coxibs and their association with adverse cardiovascular events have led physicians to re-examine the appropriate use of all NSAIDs. Part 1 of this two-part article reviews essential data related to adverse GI events to help physicians select appropriate patients to receive nonselective NSAIDs or coxibs. Other considerations, such as the benefits of proton pump inhibitors (PPIs) and the mitigating effects of concurrent aspirin use, are also discussed. Our clinical use pathway or algorithm will frame the discussion and guide clinicians through what has become a difficult decision in daily practice.
Stillman
Martin J
MJ
Department of Medicine, Hennepin County Medical Center, and University of Minnesota Medical School, Minneapolis, MN, USA.
Stillman
M Thomas
MT
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use; D000075202:Contraindications; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D010146:Pain / Q000145:classification / Q000188:drug therapy*; D054328:Proton Pump Inhibitors
D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors; D054328:Proton Pump Inhibitors