[Recommendations for treatment with nonsteroidal anti-inflammatory drugs]

Recommendations for treatment with NSAIDs that take into account the latest study results must note that both the duration of treatment and the NSAID dose must be kept as small as possible. Elevated gastrointestinal risk is the rationale for the use of selective COX-2 inhibitors in place of conventional NSAIDs, or, where indicated, co-medication with a proton pump inhibitor. A manifest cardiovascular risk is aggravated by the use of coxibs, but probably also by the administration of traditional NSAIDs. Cardioprotective medication in the form of low-dose acetyl salicylic acid can probably reduce the cardiovascular risk, but at the same time increases the gastrointestinal risk. In such cases, proton pump inhibitors can offer some relief. However, the latter have no effect on the situation in the lower gastrointestinal tract. In patients with an elevated cardiovascular risk, the use of coxibs, and probably also NSAIDs for the treatment of pain, is problematical. The decision on what treatment to apply should be made on the basis of a benefit/risk assessment, and consideration should be given to alternative therapeutic strategies.