Aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) and more recently coxibs have revolutionised management of inflammatory and other connective tissue disorders.
They have made a major contribution in their analgesic or pain relieving effect and also many are valuable in conditions such as migraine and dysmenorrhoea, while aspirin has useful antithrombotic actions in ischaemic heart disease.
Anti-inflammatories are the third most commonly prescribed group of drugs in Australia, representing 7.3 per cent of all GP's prescriptions. NSAIDs and coxibs account for 5.5 per cent of all prescriptions and also up to 25 per cent of all reported adverse drug reactions in Australia. Similar figures apply in the UK. In the 12 months to June 2002 celecoxib was the 8th and rofecoxib was the 10th most frequently prescribed medication by GPs in Australia.
The rate of anti-inflammatory use is increasing now that musculo-skeletal conditions account for 17.7 per cent of all GP consultations. Aspirin has been available over the counter for many years and its use is high and probably underestimated.
The widespread use of these medications means that their side effects present a common problem.
To balance benefits and risks, all medications need continuous review. Accumulating information about the risks associated with anti-inflammatories means their use needs careful justification. With traditional NSAIDs, prophylaxis to prevent ulcers and complications may need consideration. Even low dose aspirin has a significant risk of causing peptic ulceration and bleeding. To watch the video on Ulcers please click here assets/documents/Benign_stomach_ulcer.wmv
The COX-2 selective inhibitors have a better gastrointestinal safety profile than non selective NSAIDs. However some have been withdrawn because of adverse cardiac events and the group as a whole is under scrutiny. These issues are particularly important in patients with existing or previous peptic ulcers if they need anti-inflammatories or aspirin.
To view the full booklet go to: assets/documents/Therapy with NSAIDS Coxibs Aspirin Booklet 2005.pdf
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