NSAIDs: Therapeutic use and variability of response in adults
- Daniel H Solomon, MD, MPH
Daniel H Solomon, MD, MPH
- Matthew H. Liang Distinguished Chair in Arthritis and Population Health
- Professor of Medicine
- Harvard Medical School
- Section Editor
- Daniel E Furst, MD
Daniel E Furst, MD
- Section Editor — Treatment Issues in Rheumatology
- Clinical professor, University of Washington, Seattle
- Clinical professor, University of Florence, Florence, Italy
- Professor of Rheumatology, University of California in Los Angeles (Emeritus)
- Director of Research, Pacific Arthritis Associates
More than 20 different nonsteroidal antiinflammatory drugs (NSAIDs) are available commercially, and these agents are used worldwide for their analgesic antipyretic and antiinflammatory effects for multiple medical conditions.
The choice of NSAID in a given patient depends upon a number of factors. The responses to NSAIDs differ between patients, and individual patients differ in their response to different NSAIDs. The bases for these variable responses are only partially understood. In addition, the selection and safety of NSAIDs depends in substantial part upon the presence of absence of various comorbidities and other medications the patient is receiving.
This topic will review the issues surrounding the differences in response to the various NSAIDs. Clinical considerations in the use of these agents, including comorbidities and cotherapies, will also be presented here. The pharmacology, mechanisms of action, and adverse effects of NSAIDs are reviewed in detail separately. (See "NSAIDs: Pharmacology and mechanism of action" and "Nonselective NSAIDs: Overview of adverse effects" and "Overview of selective COX-2 inhibitors", section on 'Toxicities and possible toxicities'.)
VARIABILITY OF RESPONSES
At equipotent doses, the efficacy of the various nonsteroidal antiinflammatory drugs (NSAIDs) in patient populations is similar, although there is clear individual variation in therapeutic and adverse responses to these agents; some patients seem to respond better to one drug than to others, and responses differ between patients. The differences in the effects of the various NSAIDs have been ascribed primarily to variations in one or more of the following:
●Mechanism of action, including absolute and relative differences in cyclooxygenase (COX) enzyme inhibition and different capacities for altering non-prostaglandin-mediated biologic events (see "NSAIDs: Pharmacology and mechanism of action" and 'Prostaglandin-mediated' below and 'Nonprostaglandin-mediated' below)
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- VARIABILITY OF RESPONSES
- Effects of mechanisms of action
- - Prostaglandin-mediated
- - Nonprostaglandin-mediated
- Pharmacologic properties and clinical effects
- ISSUES IN THE THERAPEUTIC USE OF NSAIDS
- General principles
- - Dosing and duration
- - Laboratory monitoring
- Drug interactions and comorbidities
- - Drug interactions
- - NSAID use and comorbidities
- INFORMATION FOR PATIENTS