No

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

Dermatologic: Rash

Gastrointestinal: Nausea, dyspepsia, abdominal pain, anorexia, flatulence, vomiting

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, leukocytes

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 precursors

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 adverse effects):

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

Dizziness is common; may cause nervousness; may rarely cause drowsiness, confusion, insomnia, or depression

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 levels

No information available to require special precautions

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 warfarin (Coumadin®).

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 recommended.

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.

Graham DY, "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.