Safety of non-steroidal anti-inflammatory drugs.

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used in medical practice for treating pain, inflammation and degenerative joint diseases (for instance, arthritis). The use of traditional NSAIDs (tNSAIDs), however, is associated with an increased risk of minor and serious gastrointestinal (GI) events. It is estimated that in the European Union thousands of gastrointestinal complications are caused by the use of NSAIDs. A new class of NSAIDs, the “Coxibs”, was developed specifically to minimize the risk of gastrointestinal events. Since their introduction, however, the use of these newer NSAIDs raised concerns as they may increase the risk of cardiovascular events (CV), among which myocardial infarction and ischemic stroke. In this context, the risk of gastrointestinal events has to be balanced against the risk of cardiovascular events. Both risks may differ in a single subject and for over 40 different NSAIDs that are available in the EU. For children the risk of asthmatic exacerbations, renal and hepatic failure, anaphylaxis, Reye’s and Steven Johnsons’ syndromes are also of concern.