The role of dose reduction with NSAID use

Effective pain relief with use of nonsteroidal anti-inflammatory drugs (NSAIDs) may come at the cost of an increased risk for serious cardiovascular (CV), gastrointestinal (GI), and renal complications. Research has shown that these adverse events are more likely to occur with higher NSAID dosing and in individuals with a preexisting risk for CV and GI complications. To minimize the potential risk for an adverse event, numerous regulatory bodies and medical societies recommend using the lowest effective NSAID dose for the shortest time necessary. One potential strategy is to offer patients lower doses of standard NSAID formulations. However, efforts to modify physician prescribing behavior may be challenging because of concerns regarding the potential for suboptimal pain management. Another strategy has emerged through use of new technology that produces submicron NSAID formulations. This new technology is also an approach that could provide effective pain relief at low doses. This article reviews the role of dose and duration in the risk for NSAID-associated adverse events, and discusses the potential benefits associated with new low-dose submicron NSAID formulations.