HelixTalk Episode #95 - The Ultimate Guide to NSAIDs: An In-Depth Drug Class Review

Date posted: May 7, 2019, 6:00 am

In this episode, we will review the pharmacology, efficacy, and safety of the most common NSAIDs on the market.

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Key Concepts

1. At equipotent doses, NSAIDs have similar efficacy for pain/inflammation in conditions like gout, osteoarthritis, and other common NSAID indications.  Indomethacin is not superior to other NSAIDs in gout.
2. All NSAIDs have at least three boxed warnings related to GI toxicity (bleeding, ulceration, perforation); cardiovascular thrombotic events (heart attack, stroke); and avoiding use in the peri-operative setting of coronary artery bypass graft (CABG).
3. NSAID drug interaction with aspirin (and subsequent increased cardiovascular risk) may be mitigated by taking aspirin 30 minutes before the first NSAID dose of the day and favoring naproxen over other NSAIDs.
4. GI toxicity risk can be mitigated by concomitant use of proton pump inhibitors (best efficacy), histamine-2 receptor antagonists (moderate efficacy), or misoprostol (poorly tolerated by most patients due to diarrhea and abdominal discomfort).

References

• Chou R, McDonagh MS, Nakamoto E, et al. Analgesics for Osteoarthritis: An Update of the 2006 Comparative Effectiveness Review [Internet]. https://effectivehealthcare.ahrq.gov/topics/osteoarthritis-pain/research. Rockville (MD): Agency for Healthcare Research and Quality (US); 2011 Oct. Report No.: 11(12)-EHC076-EF. AHRQ Comparative Effectiveness Reviews.