The dangers of NSAIDs: look both ways.

Abstract

Preventable adverse drug reactions (ADRs) are responsible for 10% of hospital admissions in older people at a cost of around £800 million annually. Non-steroidal anti-inflammatory drugs (NSAIDs) are responsible for 30% of hospital admissions for ADRs, mainly due to bleeding, heart attack, stroke, and renal damage.1 In primary care 6% of patients prescribed NSAIDs reconsulted their GP with a potential ADR over the next 2 months. Most of these ADRs are avoidable because vulnerable groups and drug interactions can be predicted. Given that over 15 million NSAID prescriptions were dispensed in England in 2014, even a low rate of ADRs translates into a major cumulation of harm. Despite contraindications and guidance for the use of NSAIDs, their use in high-risk groups remains substantial and there has been no overall reduction in volume of NSAID prescribing. Safety is a system-wide attribute; what more should be done? Non-steroidal anti-inflammatory drugs (NSAIDs) in a blister pack. The active ingredient is diclofenac diethylammonium. Collection: Medical Photographic Library. Credit: Julie Reza, Wellcome Images, 2007. From the first day of use, all NSAIDs increase the risk of gastrointestinal (GI) bleeding, myocardial infarction, and stroke. NSAIDs reduce prostaglandin synthesis, with differences in the extent of inhibition of the enzymes COX-1 and COX-2. All NSAIDs increase both bleeding and cardiovascular disease (CVD) risk but selective COX-2 inhibitors are more likely to cause cardiovascular events, whereas less selective NSAIDs are more likely to cause GI bleeds. The risk of bleeding and of cardiovascular events is …