Nonsteroidal antiinflammatory drugs: benefit/risk evaluation in rheumatic diseases

Side effects of nonsteroidal antiinflammatory drug (NSAID) therapy are attributed to direct damage by the acidic compounds and to the secondary effects of prostaglandin inhibition. In general, gastrointestinal, skin and central nervous system effects predominate, followed by general adverse hepatic and renal events. Advanced age, female gender, history of gastrointestinal disorders and renal impairment increase the risk of NSAID induced side effects. Pharmacologic modifications that may help minimize side effects include lowered cyclooxygenase inhibitor activity, more stable plasma/tissue concentrations, decreased lipophilicity, avoidance of biliary excretion and renal excretion in inactive form. Prescribing NSAID according to their differing pharmacokinetic profiles may help maximize clinical efficacy and reduce side effects.