High Incidence Of Gastrointestinal Side Effects Research Articles

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are Associated with a High Incidence of Gastrointestinal Side-Effects

Inhibition of the cyclooxygenase  (COX) enzyme is the basis for both the efficacy and toxicity of NSAIDs. The aim of this study was to avaluate the non-steroidal anti-inflammatory drugs were used in neuro polyclinic hospital of Dr. Mintohardjo Jakarta, and to evaluate gastrointestinal tolerability of meloxicam 15 mg compared with diclofenac sodium 100 mg. The methode of this study was cross-sectional observation and  cohort prospective on December 2010-March 2011. The data of dyspepsia associated were used non-steroidal anti-inflammatory drugs consist of pain in upper abdomen, nausea, vomiting, upper  abdominal bloating and early satiety collected with PADYQ (The porto alegre dyspeptic symptoms questionnaire) were assessed at baseline and after 2 and 4 weeks of treatment. The non-steroidal anti-inflammatory drugs used in neuro polyclinic hospital of Dr. Mintohardjo Jakarta were meloxicam (48.21%), diclofenac sodium (31.07%), mefenamic acid (15.36%), piroxicam (3.93%)  dan acetaminophen (1.43%). Insiden of adverse event after 2 weeks treatment was significantly lower in the meloxicam group compared with diclofenac sodium group in pain in upper abdomen and upper abdominal bloating (p=0.020 and  p=0.037). These result suggest that meloxicam was much better tolerated than diclofenac sodium after 2 weeks treatment.

Management of late intrauterine death using a combination of mifepristone and misoprostol—experience of two regimens

Objective: To determine the safety and effectiveness of managing intrauterine death after 24 weeks gestation using a combination of mifepristone and misoprostol. Study design: Two regimens are compared. Twenty-nine women (group one) were managed using a combination of oral mifepristone and vaginal/oral misoprostol. After a change in dosage and route of administration, a further 20 women were managed with oral mifepristone and vaginal misoprostol (group two). Results: All women delivered vaginally. The mean induction to delivery interval in group one was 7 h compared with 10.2 h in group two. Group two experienced fewer gastrointestinal side-effects than group one. Conclusion: This study confirms that the combined use of mifepristone and misoprostol is a safe and effective way of managing IUD after 24 weeks gestation. Regimen one results in a shorter induction to delivery interval but is associated with a higher incidence of gastrointestinal side-effects.

Cyclosporin: Poorly Tolerated in Familial Mediterranean Fever

Cyclosporin is poorly tolerated in patients with amyloidosis due to familial mediterranean fever who are receiving colchicine. There is a high incidence of gastrointestinal side-effects and muscle weakness, both of which are reversible on stopping cyclosporin. Thus in patients with amyloidosis secondary to familial mediterranean fever treated with colchicine, the use of cyclosporin as an immunosuppressive agent may be restricted.

Effects of guar-pasta on serum lipid levels in obese diabetic and non-diabetic women with normal lipids.

Alternative medications for hyperlipidemia management have been continuously searched for above all because currently employed drugs appear not to be effective or are poorly tolerated. Fibers, such as guar-gum, seem to be able to reduce cholesterol levels, but their extensive and long-term use is beset by the high incidence of gastrointestinal side-effects. In this study the administration of guar-enriched pasta has proved to reduce fasting and post-prandial cholesterol levels significantly in 15 obese normocholesterolemic women (5 diabetics and 10 non-diabetics). The women reported good palatableness of guar-pasta without any side-effects.

7 Anti-progesterones for the interruption of pregnancy

Therapeutic abortion can be performed effectively and safely by vacuum aspiration of the uterus up to 12 weeks of amenorrhoea. Although the operative procedure could be regarded as simple, complications do occur and attempts have been made to develop non-surgical means of terminating pregnancy in the first 3-4 weeks following the first missed menstrual period. A variety of PG analogues have been developed which induce abortion in over 90% of women when given by vaginal pessary or intramuscular injections (see Bygdeman, 1984). In a large multicentre study (WHO, 1987) 0.5 mg sulprostone, administered three times with 3 h intervals, was recently found to be equally as effective as vacuum aspiration for termination of early pregnancy. The frequencies of complete abortion were 91 and 94%, respectively. However, the widespread acceptance of PG treatment is limited by a relatively high incidence of gastrointestinal side-effects and uterine pain. Treatment with antiprogesterones, both mifepristone and epostane, effectively induces abortion during early pregnancy, but the frequency of complete abortion is too low to be clinically acceptable. It remains to be demonstrated if other antiprogesterones such as ZK 98.734 and ZK 98.299, currently under development, may change this conclusion. Administration of mifepristone induces uterine contractions and increases the sensitivity of the myometrium to prostaglandins. These effects allowed the development of sequential treatment with a low dose of mifepristone and PG analogues administered vaginally or intramuscularly. The combined therapy has been shown to be highly effective (frequency of complete abortion between 95 and 100%) and is seemingly associated with a lower frequency of side-effects than if PG analogues are used alone. Whether this medical abortion method will be a realistic alternative to vacuum aspiration during the first 8 weeks of pregnancy depends on the outcome of further clinical trials, including randomized studies comparing the two procedures. It has been shown that mifepristone crosses the placenta (Frydman et al, 1985). An important factor which needs to be verified in future studies is therefore the possible embryotoxicity of this type of compound. The risk that pregnancy continues in spite of treatment can never be excluded.(ABSTRACT TRUNCATED AT 400 WORDS)

Epidemiology of NSAID-induced gastrointestinal problems and the role of cimetidine in their prevention.

It is difficult to ascertain the incidence of gastrointestinal side-effects associated with intake of non-steroidal anti-inflammatory drugs (NSAIDs). In retrospective studies, some NSAIDs have been reported to be associated with a higher incidence of gastrointestinal side-effects than others. However, this has not been verified either in a prospective case-review study or in a large double-blind study. Serious side-effects, such as bleeding, perforation and heart failure, occur in approximately 1% of patients using NSAIDs. One-third of all patients receiving NSAIDs will have gastrointestinal complaints. Since at least 10% of patients terminate treatment with NSAIDs as a result of side-effects, even reduction of those that are not life-threatening would be of great benefit. H2-receptor antagonists have proved effective in ulcer treatment, and their use as prophylaxis against the side-effects of NSAIDs is being widely studied. In a recent study, 63 patients who had experienced serious upper gastrointestinal side-effects were given cimetidine while continuing their NSAID therapy. All but 4 of the 47 who had gastric or duodenal ulcer on first admission were healed at 8 weeks, and none of the remaining 16 with diffuse bleeding gastritis experienced further clinical episodes of bleeding or ulcer-related dyspepsia.