title: Evolution to low-dose NSAID therapy.
abstract: All NSAIDs are to varying degrees associated with gastrointestinal, cardiovascular and renal adverse effects (AEs). Differences in selectivity for inhibition of the COX isozymes (COX-1/COX-2) have been used as an indicator of the likelihood of experiencing an AE, but the measure of 'selectivity' commonly used is less than desirable, and selectivity has not yielded unequivocal superior safety. Recent guidelines recommend that NSAIDs be used at the lowest effective dose and for the shortest period of time. In response, 'low-dose' NSAID formulations have been developed. Such formulations may help by reducing overall systemic exposure, thereby reducing the frequency or severity of AEs. It seems timely to review the need, rationale and application of such an approach.
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Department of Pharmacology, Temple University School of Medicine, Philadelphia, PA, USA.
authors.forename: Joseph V
authors.initials: JV
authors.lastname: Pergolizzi
authors.affiliation: Department of Pharmaceutical Sciences, Temple University School of Pharmacy, Philadelphia, PA, USA.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Raffa
authors.affiliation: International Clinical Research Institute, Overland Park, KS, USA.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Nalamachu
authors.affiliation: NEMA Research, Naples, FL, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Taylor
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000009:adverse effects* / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000517:prevention & control; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D006801:Humans; D020128:Inhibitory Concentration 50; D010146:Pain / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D051437:Renal Insufficiency / Q000139:chemically induced / Q000517:prevention & control; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors
keywords: NSAID; acute pain; adverse effects; chronic pain