ADVERSE REACTIONS TO NONSTEROIDAL ANTI-INFLAMMATORY DRUGS

Abstract

Aspirin or acetylsalicylic acid (ASA) was first synthesized in 1897 by Felix Hoffmann, an employee of the Bayer Company in Germany. For the past 100 years, aspirin, the first nonsteroidal anti-inflammatory drug (NSAID), has been used by billions of individuals as an anti-inflammatory, analgesic, and antipyretic agent. For the past 40 years, ASA's platelet-inhibitory activity has been used to prevent arterial thrombosis. Since the 1960s, a growing list of additional NSAIDs have been synthesized and marketed worldwide, mainly for their anti-inflammatory effects in the treatment of arthritis. Some NSAIDs, such as ibuprofen and naproxen, are currently sold over the counter for alleviation of headaches, menstrual cramps, musculoskeletal pain syndromes, and inflammatory arthritis. Other NSAIDs are dispensed by prescription and are mostly used to treat musculoskeletal disorders and arthritis (Table 1). Exposure of humans to ASA and NSAIDs is enormous, and, for the most part, these drugs are well tolerated. ASA and the other NSAIDs induce a number of adverse side effects. Some adverse reactions are caused by the shared pharmacologic effects of all NSAIDs in inhibiting a ubiquitous enzyme, cyclo-oxygenase (e.g., in gastritis, peptic ulcerations, and nephritis). Other reactions are idiosyncratic, drug-specific, and include hepatitis, erythema multiforme, and multiple blood dyscrasias. 83 In addition, several pseudo-allergic and allergic adverse reactions to ASA and other NSAIDs have been recognized. This article reviews these diverse reactions to ASA and other NSAIDs in detail (Table 2). In addition, current investigations of alleged adverse effects and cross-reactivity of food additives and dyes also are reviewed.