Nonsteroidal Anti-Inflammatory Agent (NSAID)
Acute and long-term use in the management of signs and symptoms of
osteoarthritis and rheumatoid arthritis
C (D in 3rd trimester)
Aspirin allergy, 3rd trimester pregnancy or allergy to oxaprozin, history of
GI disease, renal or hepatic dysfunction, bleeding disorders, cardiac failure,
elderly, debilitated, nursing mothers
GI toxicity (bleeding, ulceration, perforation); CNS effects may occur
(headaches, confusion, depression); dehydration, hypersensitivity, anaphylactoid
reactions (intermittent tolmetin use more often); renal function decline, acute
renal insufficiency, interstitial nephritis, dysuria, cystitis, hematuria,
nephrotic syndrome, hyperkalemia in acute renal insufficiency, hyponatremia,
papillary necrosis, hepatic function impairment; elderly have increased risk for
adverse reactions to NSAIDs
1% to 10%:
Central nervous system: CNS inhibition, disturbance of sleep
Gastrointestinal: Nausea, dyspepsia, abdominal pain, anorexia, flatulence,
Genitourinary: Dysuria or frequency
<1%: Anaphylaxis, serum sickness, edema, change in blood pressure, peptic
ulcer and/or GI bleed, LFT abnormalities, stomatitis, rectal bleeding,
pancreatitis, anemia, thrombocytopenia, leukopenia, ecchymosis, agranulocytosis,
pancytopenia, weight gain, weight loss, weakness, malaise, symptoms of upper
respiratory infection, pruritus, urticaria, photosensitivity, exfoliative
dermatitis, erythema multiforme, Stevens-Johnson syndrome, blurred vision,
conjunctivitis, acute interstitial nephritis, nephrotic syndrome, hematuria,
renal insufficiency, acute renal failure, decreased menstrual flow
Symptoms of overdose include acute renal failure, vomiting, drowsiness,
Management of a nonsteroidal anti-inflammatory drug (NSAID) intoxication is
primarily supportive and symptomatic. Fluid therapy is commonly effective in
managing the hypotension that may occur following an acute NSAID overdose,
except when this is due to an acute blood loss. Seizures tend to be very
short-lived and often do not require drug treatment. Although, recurrent
seizures should be treated with I.V. diazepam. Since many of the NSAID undergo
enterohepatic cycling, multiple doses of charcoal may be needed to reduce the
potential for delayed toxicities.
ACE-inhibitor effects may be decreased by concurrent therapy with NSAIDs
Increased toxicity: Aspirin, oral anticoagulants, diuretics
Inhibits prostaglandin synthesis by decreasing the activity of the enzyme,
cyclo-oxygenase, which results in decreased formation of prostaglandin
Absorption: Almost completely
Protein binding: >99%
Half-life: 40-50 hours
Time to peak: 2-4 hours
Adults: Oral (individualize dosage to lowest effective dose to minimize
Rheumatoid arthritis: 1200 mg once daily
Maximum dose: 1800 mg/day or 26 mg/kg (whichever is lower) in divided doses
Monitor blood, hepatic, renal, and ocular function
|Mental Health: Effects
on Mental Status|
Dizziness is common; may cause nervousness; may rarely cause drowsiness,
confusion, insomnia, or depression
Effects on Psychiatric
May rarely cause agranulocytosis; use caution with clozapine and
carbamazepine; may decrease lithium clearance resulting in an increase in serum
lithium levels and potential lithium toxicity; monitor serum lithium
|Dental Health: Local
No information available to require special precautions
Effects on Dental Treatment|
NSAID formulations are known to reversibly decrease platelet aggregation via
mechanisms different than observed with aspirin. The dentist should be aware of
the potential of abnormal coagulation. Caution should also be exercised in the
use of NSAIDs in patients already on anticoagulant therapy with drugs such as
Take this medication exactly as directed; do not increase dose without
consulting prescriber. Do not crush tablets or break capsules. Take with food or
milk to reduce GI distress. Maintain adequate fluid intake (2-3 L/day of fluids
unless instructed to restrict fluid intake). Do not use alcohol, aspirin, or
aspirin-containing medication, and all other anti-inflammatory medications
without consulting prescriber. You may experience drowsiness, dizziness, or
nervousness (use caution when driving or engaging in tasks requiring alertness
until response to drug is known); anorexia, nausea, vomiting, or heartburn
(frequent small meals, frequent mouth care, sucking lozenges, or chewing gum may
help). GI bleeding, ulceration, or perforation can occur with or without pain;
discontinue medication and contact prescriber if persistent abdominal pain or
cramping, or blood in stool occurs. Report vaginal bleeding; breathlessness,
difficulty breathing, or unusual cough; chest pain, rapid heartbeat,
palpitations; unusual bruising/bleeding; blood in urine, stool, mouth, or
vomitus; swollen extremities; skin rash or itching; acute fatigue; or swelling
of face, lips, tongue, or throat. Pregnancy/breast-feeding precautions:
Inform prescriber if you are or intend to be pregnant. Breast-feeding is not
Monitor blood, hepatic, renal, and ocular function
Tablet: 600 mg
Brooks PM and Day RO,
"Nonsteroidal Anti-inflammatory Drugs - Differences and Similarities," N Engl
J Med, 1991, 324(24):1716-25.
Clinch D, Banerjee AK, Ostick G,
"Absence of Abdominal Pain in Elderly Patients With Peptic Ulcer," Age
Ageing, 1984, 13(2):120-3.
Clive DM, Stoff JS,
"Renal Syndromes Associated With Nonsteroidal Anti-inflammatory Drugs," N
Engl J Med, 1984, 310(9):563-72.
"Prevention of Gastroduodenal Injury Induced by Chronic Nonsteroidal Anti-inflammatory Drug Therapy,"
Gastroenterology, 1989, 96(2 Pt 2 Suppl):675-81.
Gurwitz JH, Avorn J, Ross-Degnan D, et al,
"Nonsteroidal Anti-Inflammatory Drug-Associated Azotemia in the Very Old,"
JAMA, 1990, 264(4):471-5.
Hawkey CJ, Karrasch JA, Szczepanski L, et al,
"Omeprazole Compared With Misoprostrol for Ulcers Associated With Nonsteroidal Anti-inflammatory Drugs,"
N Engl J Med, 1998, 338(11):727-34.
Pounder R, "Silent Peptic Ulceration: Deadly Silence or Golden Silence?"
Gastroenterology, 1989, 96:(2 Pt 2 Suppl)626-31.
Yeomans ND, Tulassay Z, Juhasz L, et al,
"A Comparison of Omeprazole With Ranitidine for Ulcers Associated With Nonsteroidal Anti-inflammatory Drugs,"
N Engl J Med, 1998, 338(11):719-26.
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