title: [DGRh recommendations for the implementation of current security aspects in the NSAID treatment of musculoskeletal pain].
abstract: NSAIDs exert their anti-inflammatory and analgesic effects by inhibition of COX‑2, a key enzyme for proinflammatory prostanoid synthesis. Therapy with NSAIDs is limited by their typical gastrointestinal, cardiovascular and renal side effects, which are caused by inhibition of COX‑1 (gastrointestinal toxicity), COX‑2 (cardiovascular side effects) or both COX-isoenzymes (renal side effects). Appropriate prevention strategies should be employed in patients at risk. If gastrointestinal risk factors are present, co-administration of a proton pump inhibitor or misoprostol is recommended; in patients with cardiovascular risk, coxibs, diclofenac and high-dose ibuprofen should be avoided. Furthermore, drug interactions and contraindications should be considered. In patients with renal impairment (GFR < 30 ml/min) all NSAIDs must be avoided. Ulcer anamnesis is a contraindication for traditional NSAIDs. Preexisting cardio- or cerebrovascular diseases are contraindications for coxibs. Treatment decisions should be individually based with a continuous monitoring of the risk - benefit ratio and exploitation of non-pharmacological treatment options.
authors.affiliation: Abt. Rheumatologie, Klaus Miehlke Klinik, Leibnizstr. 23, 65191, Wiesbaden, Deutschland. wbolten@em.uni-frankfurt.de.
authors.forename: W W
authors.initials: WW
authors.lastname: Bolten
authors.affiliation: Praxiszentrum Rheumatologie, München, Deutschland.
authors.forename: K
authors.initials: K
authors.lastname: Krüger
authors.affiliation: Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM), Bonn, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Reiter-Niesert
authors.affiliation: Institut für Klinische Pharmakologie, Med. Hochschule, Hannover, Deutschland.
authors.forename: D O
authors.initials: DO
authors.lastname: Stichtenoth
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000009:adverse effects; D018771:Arthralgia / Q000175:diagnosis* / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000517:prevention & control*; D005858:Germany; D006801:Humans; D010147:Pain Measurement / Q000187:drug effects / Q000592:standards; D017410:Practice Guidelines as Topic; D012219:Rheumatology / Q000592:standards*; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: Contraindications; Drug safety; Interactions; Musculoskeletal pain; Non-steroidal anti-inflammatory drugs