Pain treatment with NSAIDs, primary focus on ibuprofen

For the past 30 years ibuprofen has been known as one of the safest NSAIDs and in some countries, including The Netherlands, it is available as an over-the-counter medicine. Nevertheless, all NSAIDS may show adverse effects, such as gastrointestinal toxicity, sodium/water retention, reduced kidney perfusion and allergic responses. In developing safer NSAIDs two new types of drug have been introduced: the COX-2 inhibitors and the single enantiomer NSAIDs, in particular S(+)-ibuprofen. S(+) ibuprofen shows an equipotency with half of the racemic ibuprofen dose , and the introduction of S(+) ibuprofen (dexibuprofen, Seractil) permits the prescription of lower doses. The new COX-2 inhibitors have recently been compared to the racemic ibuprofen. Day et al. found no significant difference between rofecoxib and racemic ibuprofen concerning overall incidence rates of clinical adverse experiences. In the study by Silverstein et al. the annualised incidence rates of upper GI ulcer complications alone and combined with symptomatic ulcers for celecoxib vs ibuprofen showed no statistical difference (P = 0.09), but for patients not taking aspirin, a difference was found in favour of celecoxib (P = 0.04). Studies comparing the COX-2 inhibitors and dexibuprofen need to be performed.