Use Of Naproxen Research Articles

Viscosupplementation for Osteoarthritis of the Knee

ForewordThis Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are reviewed. Relevant formal guidelines, if they exist, are presented. The article ends with the author’s clinical recommendations.StageA 67-year-old woman with right-knee osteoarthritis is referred by her primary care physician for treatment of her knee pain. The patient weighs 83 kg and is 161 cm tall, and her body-mass index (the weight in kilograms divided by the square of the height in meters) is 32. She has had pain intermittently for 9 years, which has been relieved with infrequent use of naproxen. She has recently become more sedentary and is finding it increasingly difficult to play golf. A recent radiograph of her right knee reveals moderate joint-space narrowing and osteophytes, affecting primarily the medial tibiofemoral compartment . . .

Recurrent angioedema after naproxen use in a patient stabilized with losartan

Recurrent angioedema after naproxen use in a patient stabilized with losartan

THU0090 Cardiovascular Morbidity in Patients with Ankylosing Spondylitis: A Population-Based Cohort Study

BackgroundIt is well recognized that rheumatoid arthritis is an independent risk factor for cardiovascular (CV) disease. For ankylosing spondylitis (AS), the literature on this risk is relatively scarce, and shows...

FRI0119 Diclofenac Use and Risk of Myocardial Infarction in Spondyloarthropathy Patients

BackgroundAnkylosing spondylyitis (AS) and Psoriatic arthritis (PsA) have been associated with increased risk of myocardial infarction (MI). Diclofenac use has been associated with MI in the general population and is...

Potential of prescription registries to capture individual-level use of aspirin and other nonsteroidal anti-inflammatory drugs in Denmark: trends in utilization 1999-2012.

BackgroundDue to over-the-counter availability, no consensus exists on whether adequate information on nonsteroidal anti-inflammatory drug (NSAID) use can be obtained from prescription registries.ObjectivesTo examine utilization of aspirin and nonaspirin NSAIDs in Denmark between 1999 and 2012 and to quantify the proportion of total sales that was sold on prescription.MethodBased on nationwide data from the Danish Serum Institute and the Danish National Prescription Registry, we retrieved sales statistics for the Danish primary health care sector to calculate 1-year prevalences of prescription users of aspirin or nonaspirin NSAIDs, and to estimate the corresponding proportions of total sales dispensed on prescription.ResultsBoth low-dose aspirin and nonaspirin NSAIDs were commonly used in the Danish population between 1999 and 2012, particularly among elderly individuals. The 1-year prevalence of prescribed low-dose aspirin increased throughout the study period, notably among men. Nonaspirin NSAID use was frequent in all age groups above 15 years and showed a female preponderance. Overall, the prevalence of prescribed nonaspirin NSAIDs decreased moderately after 2004, but substantial variation according to NSAID subtype was observed; ibuprofen use increased, use of all newer selective cyclooxygenase-2 inhibitors nearly ceased after 2004, diclofenac use decreased by nearly 50% after 2008, and naproxen use remained stable. As of 2012, the prescribed proportion of individual-level NSAID sales was 92% for low-dose aspirin, 66% for ibuprofen, and 100% for all other NSAIDs.ConclusionThe potential for identifying NSAID use from prescription registries in Denmark is high. Low-dose aspirin and nonaspirin NSAID use varied substantially between 1999 and 2012. Notably, use of cyclooxygenase-2 inhibitors nearly ceased, use of diclofenac decreased markedly, and naproxen use remained unaltered.

Osteoarthritis of the hand II: chemistry, pharmacokinetics and pharmacodynamics of naproxen, and clinical outcome studies

This article aims to review osteoarthritis of the hand and the role of the non-steroidal anti-inflammatory drug (NSAID) naproxen on its management. We discuss the chemical and pharmacological properties of naproxen and the NSAID class, with an emphasis on its mechanism and adverse reactions. In the context of part I of this paper in characterizing hand osteoarthritis (OA), we review clinical trials that have been conducted involving hand OA and naproxen. The therapeutic effect of NSAIDs stems from its role on inhibiting cyclo-oxygenase (COX)-1 or COX-2 enzyme activity in the body. These enzymes play a major role in maintaining several functions in the body and due NSAIDs' inhibitory effects; many principle adverse reactions occur with the use of NSAIDs such as: gastrointestinal tract issues, cardiovascular risks, renal, hepatic, central nervous system and cutaneous. Review of clinical trials involving naproxen and hand OA show that it is significantly more efficacious when compared with placebo. These studies, along with the finding that naproxen is of least cardiovascular risk in the NSAID class, may show that it can be part of one of the approaches in managing the condition. It is important to note that the optimal NSAID to use varies for each individual. The finding that the use of naproxen leads to the smallest increase in cardiovascular risk appeals to those at-risk individuals who suffer from OA and require pharmacological treatment for relief.

Use of analgesics and risk of death after discharge from elective hip or knee replacement - a nationwide cohort study

Purpose: Individual drugs for pain management may have different risk profile, especially among elderly individuals. We investigated the risk of mortality with use of analgesics during the first six months after discharge from elective hip or knee replacement surgery. Methods: Through cross-linkage of Danish nationwide administrative registers, we identified patients discharged alive after elective hip or knee replacement between mid 2004 and end 2009. Risk of mortality during the first six months associated with use of diclofenac, ibuprofen, naproxen, tramadol, and morphine was analyzed by multivariable time-dependent Cox proportional hazard regression. Results: In total 28,467 patients were included (60% women and mean age 69.0 (inter quartile range 61.6-76.5) years) of which 15,573 (55%) had a total hip replacement. A total of 2,459 patients received diclofenac, 7,044 ibuprofen, 379 naproxen, 9,851 tramadol, 11,696 paracetamol, and 6,679 morphine. During follow-up 380 patients died (21 in diclofenac, 37 in ibuprofen, 2 in naproxen, 80 in tramadol, 206 in paracetamol, and 87 in morphine treatment). The adjusted Cox regression analysis demonstrated that morphine and diclofenac were associated with increased mortality (Figure) while ibuprofen, naproxen, tramadol and paracetamol were not associated with increased risk. ![Figure][1] Figure 1 Conclusions: Treatment with diclofenac or morphine during the first six months after discharge from elective hip or knee replacement was associated with increased mortality-risk. Awareness on potential risk of adverse events associated with these drugs after hip- or knee-replacement surgery is warranted. [1]: pending:yes

SAT0378 No Exclusivity for Gout in Arthritis of the First Metatarsophalangeal Joint

BackgroundMonoarthritis is the most common form of arthritis in the general practice. In primary care an arthritis of the first metatarsophalangeal (MTP) joint is almost always considered as gout. Gout...

Self-care counseling for patients with psychiatric disorders

According to the National Institute of Mental Health, 1 in 17 adults has a serious mental illness and, of those, almost one-half have two or more disorders.1.Kessler R.C. Chiu W.T. Demler O. Walters E.E. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication.Arch Gen Psychiatry. 2005; 62: 617-627Crossref PubMed Scopus (7709) Google Scholar About 18% of adults have anxiety,2.National Institute of Mental Health. The numbers count: mental disorders in Americawww.nimh.nih.gov/health/publications/thenumbers-count-mental-disorders-in-america/index.shtmlDate: 2013Google Scholar 3% have bipolar disorder,2.National Institute of Mental Health. The numbers count: mental disorders in Americawww.nimh.nih.gov/health/publications/thenumbers-count-mental-disorders-in-america/index.shtmlDate: 2013Google Scholar and between 5% and 10% are depressed.3.Centers for Disease Control and PreventionAn estimated 1 in 10 U.S. adults report depression.www.cdc.gov/features/dsdepressionDate: 2013Google Scholar In addition to psychiatric illnesses, many patients have a range of chronic medical conditions (e.g., hypertension). Pharmacists can provide valuable self-care counseling to these individuals. Pharmacists should ask patients with psychiatric disorders about their smoking status and, if needed, encourage smoking cessation. Patients with depression are more likely to smoke than those who are not depressed (29% vs. 19%).4.Sanderson Cox L. Feng S. Cañar J. et al.Social and behavioral correlates of cigarette smoking among mid-Atlantic Latino primary care patients.Cancer Epidemiol Biomarkers Prev. 2005; 14: 1976-1980Crossref PubMed Scopus (20) Google Scholar This finding also has been identified with bipolar disorder and schizophrenia. Multiple approaches (e.g., nicotine replacement therapies) are available OTC and should be discussed.■Pharmacists have important roles in promoting safe self-care practices among individuals with psychiatric illnesses.■Supplements are not well regulated, may not be safer than prescribed psychotropic drugs, and should never replace a prescription. ■Pharmacists have important roles in promoting safe self-care practices among individuals with psychiatric illnesses.■Supplements are not well regulated, may not be safer than prescribed psychotropic drugs, and should never replace a prescription. In a survey of more than 2,000 adults, 53% of those with depressive symptoms used complementary and alternative medicine (CAM), especially St. John's wort and 5-hydroxytryptophan.5.Kessler R.C. McGonagle K.A. Zhao S. et al.Lifetime and 12-month prevalence of DSM-IIIR psychiatric disorders in the United States: results from the National Comorbidity Survey.Arch Gen Psychiatry. 1994; 51: 8-19Crossref PubMed Scopus (10450) Google Scholar Other supplements such as valerian, kava, melatonin, and omega-3 fatty acids often are used by individuals with mental health issues. Counsel patients that supplements are not well regulated, may not be safer than prescribed drugs, and should never replace prescription therapy. Selective serotonin reuptake inhibitors (SSRIs) are a commonly prescribed class of antidepressants. Although safe, the development of serotonin syndrome is a serious concern when used with other serotonergic agents. Dextromethorphan possesses serotonergic activity and is present in many cough preparations. Natural products (e.g., St. John's wort, 5-hydroxytryptophan, S-adenosyl-Lmethionine) also are serotonergic and should be avoided in individuals using an SSRI or antidepressants, including duloxetine and venlafaxine. SSRIs (and serotonin-norepinephrine reuptake inhibitors) may increase the risk of bleeding, especially if taken with prescription antithrombotic agents. Patients should avoid OTC ibuprofen, naproxen, and analgesic dosages of aspirin to reduce the risk of bleeding and instead use acetaminophen. Anticholinergic effects may occur with bupropion use, so patients should be counseled to avoid OTC drugs with anticholinergic effects (e.g., diphenhydramine, dimenhydrinate, meclizine). When a patient presents with cough and cold symptoms, products to recommend include second-generation antihistamines, decongestants, and throat lozenges. Patients should avoid combination OTC cold products, as they most likely contain anticholinergic agents. Lithium remains a primary treatment for many patients with bipolar disorder. Self-care counseling should focus on any activity that would change lithium concentrations. Most importantly, changes in sodium ingestion, specifically sodium restriction, will increase the renal tubular reabsorption of lithium and result in lithium toxicity. Advise patients with concomitant bipolar disorder and hypertension to maintain adequate sodium and fluid intake. Patients taking lithium also should avoid the use of ibuprofen and naproxen, both of which can increase the renal reabsorption of lithium, resulting in increased concentrations. Tell patients to use acetaminophen for pain instead of NSAIDs. Daniel L. Krinsky, BSPharm, MS Column coordinator [email protected] Editor-in-Chief, APhA’s Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care, 17th ed. (online at PharmacyLibrary.com)

Reinitiating Aspirin Therapy for Primary Prevention of Cardiovascular Events in a Patient Post—Aspirin-Induced Upper Gastrointestinal Bleed: A Case Report and Review of Literature

To describe a case of continued aspirin use for primary prevention of a cardiovascular event in a patient post-aspirin-induced upper gastrointestinal (GI) bleed and evaluate published evidence to determine whether reinitiating aspirin therapy for this patient was appropriate. A 65-year-old man had been taking chronic low-dose (81 mg/day) aspirin therapy since 2002 for primary prevention of a cardiovascular event. He developed an upper GI bleed with lowered hemoglobin (9 mg/dL) and hematocrit (26.3%) after concomitantly taking 2 doses of naproxen (220 mg each). An objective causality assessment with the Naranjo probability scale revealed a probable adverse reaction of an upper GI bleed associated with concomitant naproxen and aspirin use. No further naproxen was taken. Aspirin was discontinued and pantoprazole was started, with resolution of the bleeding. Aspirin was restarted 2.5 months after pantoprazole was initiated, and no further bleeding occurred. Upper GI bleeds associated with aspirin therapy are well described in the literature. The management of cardiovascular event prophylaxis after a GI bleed is often controversial; consensus in regard to the optimal method of management does not exist. We evaluated GI protection strategies for patients with a history of aspirin-induced GI bleeding requiring cardiovascular prophylaxis. We found that the benefit of aspirin for the primary prevention of cardiovascular events needs to be carefully balanced with the risks associated with its use. The current literature supports that the best approach to prevent recurrent aspirin-induced GI bleeding is to administer a proton pump inhibitor with aspirin therapy. The benefit of aspirin for primary prevention of cardiovascular events needs to be carefully balanced with the risks associated with its use. Based on the current literature, the best approach to preventing recurrent aspirin-induced GI bleeds is to administer a proton pump inhibitor concomitantly with aspirin therapy.

Mucosal healing effect of mesalazine granules in naproxen-induced small bowel enteropathy

To investigate the effect of mesalazine granules on small intestinal injury induced by naproxen using capsule endoscopy (CE). This was a single center, non-randomized, open-label, uncontrolled pilot study, using the PillCam SB CE system with RAPID 5 software. The Lewis Index Score (LIS) for small bowel injury was investigated to evaluate the severity of mucosal injury. Arthropathy patients with at least one month history of daily naproxen use of 1000 mg and proton pump inhibitor co-therapy were screened. Patients with a minimum LIS of 135 were eligible to enter the 4-wk treatment phase of the study. During this treatment period, 3 × 1000 mg/d mesalazine granules were added to ongoing therapies of 1000 mg/d naproxen and 20 mg/d omeprazole. At the end of the 4-wk combined treatment period, a second small bowel CE was performed to re-evaluate the enteropathy according to the LIS results. The primary objective of this study was to assess the mucosal changes after 4 wk of mesalazine treatment. A total of 18 patients (16 females), ranging in age from 46 to 78 years (mean age 60.3 years) were screened, all had been taking 1000 mg/d naproxen for at least one month. Eight patients were excluded from the mesalazine therapeutic phase of the study for the following reasons: the screening CE showed normal small bowel mucosa or only insignificant damages (LIS < 135) in five patients, the screening esophagogastroduodenoscopy revealed gastric ulcer in one patient, capsule technical failure and incomplete CE due to poor small bowel cleanliness in two patients. Ten patients (9 female, mean age 56.2 years) whose initial LIS reached mild and moderate-to-severe enteropathy grades (between 135 and 790 and ≥ 790) entered the 4-wk therapeutic phase and a repeat CE was performed. When comparing the change in LIS from baseline to end of treatment in all patients, a marked decrease was seen (mean LIS: 1236.4 ± 821.9 vs 925.2 ± 543.4, P = 0.271). Moreover, a significant difference between pre- and post-treatment mean total LIS was detected in 7 patients who had moderate-to-severe enteropathy gradings at the inclusion CE (mean LIS: 1615 ± 672 vs 1064 ± 424, P = 0.033). According to the small bowel CE evaluation mesalazine granules significantly attenuated mucosal injuries in patients with moderate-to-severe enteropathies induced by naproxen.

Non-steroidal anti-inflammatory drugs and endometrial cancer risk in the VITamins And Lifestyle (VITAL) cohort

ObjectiveChronic inflammation may be an important factor in the initiation and promotion of endometrial cancer. Use of non-steroidal anti-inflammatory drugs (NSAIDs), however, has been inconsistently associated with endometrial cancer risk. Methods22,268 female residents of western Washington State, ages 50–76, completed a baseline questionnaire in 2000–2002 and reported on their use of individual NSAIDs over the past 10years. Use was categorized as none, low (<4days/week or <4years), and high (≥4days/week and ≥4years). Over 9years of follow-up, 262 incident invasive endometrial cancers were identified. Multivariable proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). ResultsRelative to non-use, high use of aspirin was inversely associated with endometrial cancer risk (HR 0.64, 95% CI: 0.41–1.01; P trend=0.03). Findings were stronger for regular-strength than low-dose aspirin. High use of non-aspirin NSAIDs (HR 1.15, 95% CI: 0.68–1.95), including ibuprofen (HR 1.29, 95% CI: 0.73–2.28), and naproxen (HR 1.08, 95% CI: 0.39–2.95) was not associated with risk. In subgroup analyses, findings for aspirin were strongest for cancers of endometrioid histology and were restricted to non-smokers. ConclusionsThis study provides additional evidence that use of aspirin, but not non-aspirin NSAIDs, may reduce the risk of endometrial cancer, especially in estrogen-mediated cases; however additional prospective studies with high-quality measurement of NSAID use are needed. Aspirin should continue to be examined as a potential agent for cancer chemoprevention.

Does Concomitant Use of NSAIDs Reduce the Effectiveness of Antidepressants?

Does Concomitant Use of NSAIDs Reduce the Effectiveness of Antidepressants?

Safety of Pain Therapy During Pregnancy and Lactation in Patients with Inflammatory Arthritis: A Systematic Literature Review

To systematically review the safety of various pain therapies used during pregnancy and lactation in patients with inflammatory arthritis. A systematic literature review was performed in Medline, Embase, the Cochrane Library, and the American College of Rheumatology/European League Against Rheumatism 2008-2009 meeting abstracts, as part of the multinational 3e (Evidence, Expertise, Exchange) Initiative for generating practical recommendations about Pain Management by Pharmacotherapy in Inflammatory Arthritis. Articles fulfilling predefined inclusion criteria were reviewed, and quality appraisal was performed. The search yielded a total of 3974 articles and 7 abstracts. The only study that fulfilled the criteria for pain therapies in pregnancy was a systematic review published in 2008, evaluating the effects of nonsteroidal antiinflammatory drug (NSAID) use during pregnancy in patients with rheumatic conditions. Two of the 3 studies reviewed in the 2008 publication could be included in our current review. No studies were included in the review in relation to lactation. A total of 204 malformations were identified among infants exposed to NSAID, with an OR of 1.04. The number of identified cardiac defects was higher than expected, with an OR of 1.86. There seemed to be no specificity for the type of NSAID used. Among the 6 infants with orofacial clefts, 5 occurred with naproxen use and 1 with ibuprofen. Only 2 studies evaluating the risk of NSAID use in patients with inflammatory arthritis were identified, with results suggesting a higher rate of cardiac malformations in infants exposed to NSAID during the first trimester. No studies evaluating the effects of other treatments, such as paracetamol, corticosteroids, muscle relaxants, neuromodulators, antidepressants, opioids, or opioid-like therapy in the specific context of rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, or spondyloarthritis, and no studies with respect to lactation were identified. Research is needed to improve the risk-benefit ratio of the use of pain therapies for inflammatory arthritis during pregnancy.

NSAIDs: take with food or after fasting?

Published and regulatory advice is to take NSAIDs with fluids and/or food irrespective whether NSAIDs are taken over the counter or long-term. The basis for this recommendation is not clear and we sought to establish the reasons for it through a search of published literature and personal files. Results from experimental animals show that fasting increases the gastric side effects of NSAIDs while food increases small bowel damage, but this has not been tested in humans. The possible effects of food in modifying the gastric damage caused by NSAIDs are complex, as food quantity and composition modify the responses substantially. Food usually delays peak levels of NSAIDs (and hence onset of action) without affecting total bioavailability. This may not be important when a steady state is achieved, but rapid onset of action is highly relevant for over-the-counter use of NSAIDs. The safety of over-the-counter use of ibuprofen and naproxen appears to be excellent and comparable with paracetamol. The rapid onset of action of NSAIDs is most important during over-the-counter use, in which case it may be more appropriate to take the drugs on a fasting stomach.

Naproxen as Prophylaxis against Atrial Fibrillation after Cardiac Surgery: The NAFARM Randomized Trial

Purpose We sought to assess the effect of naproxen versus placebo on prevention of atrial fibrillation after coronary artery bypass graft (CABG) surgery. Methods In this randomized, double-blind, placebo-controlled, single-center trial of 161 consecutive patients undergoing CABG surgery, patients received naproxen 275 mg every 12 hours or placebo at the same dosage and interval over 120 hours immediately after CABG surgery. The primary outcome was the occurrence of atrial fibrillation in the first 5 postoperative days. Results The incidence of postoperative atrial fibrillation was 15.2% (12/79) in the placebo versus 7.3% (6/82) in the naproxen group ( P = .11). The duration of atrial fibrillation episodes was significantly lower in the naproxen (0.35 hours) versus placebo group (3.74 hours; P = .04). There was no difference in the overall days of hospitalization between placebo (17.23 ± 7.39) and naproxen (18.33 ± 9.59) groups ( P = .44). Intensive care unit length of stay was 4.0 ± 4.57 days in the placebo and 3.23 ± 1.25 days in the naproxen group ( P = .16). The trial was stopped by the data monitoring committee before reaching the initial target number of 200 patients because of an increase in renal failure in the naproxen group (7.3% vs 1.3%; P = .06). Conclusions Postoperative use of naproxen did not reduce the incidence of atrial fibrillation but decreased its duration, in a limited sample of patients after CABG surgery. There was a significant increase in acute renal failure in patients receiving naproxen 275 mg twice daily. Our study does not support the routine use of naproxen after CABG surgery for the prevention of atrial fibrillation.

Use of nonaspirin nonsteroidal anti-inflammatory drugs during pregnancy and the risk of spontaneous abortion

The association between the use of nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) during pregnancy and the risk of spontaneous abortion remains unclear because of inconsistent research results and the lack of evidence for an effect due to specific types or dosages of nonaspirin NSAIDs. We aimed to quantify the association between having a spontaneous abortion and types and dosages of nonaspirin NSAIDs in a cohort of pregnant women. Using a nested case-control design, we obtained data from the Quebec Pregnancy Registry for 4705 women who had a spontaneous abortion. For each instance, we randomly selected 10 controls from the remaining women in the registry who were matched by index date (date of the spontaneous abortion) and gestational age. Use of nonaspirin NSAIDs (identified by filled prescriptions) and nonuse were compared. We also looked for associations between different types and dosages of nonaspirin NSAIDs and having a spontaneous abortion. Analyses of associations and adjustment for confounding were done using conditional logistic regression. We identified 4705 cases of spontaneous abortion (352 exposed [7.5%]); 47 050 controls (1213 exposed [2.6%]). Adjusting for potential confounders, the use of nonaspirin NSAIDs during pregnancy was significantly associated with the risk of spontaneous abortion (odds ratio [OR] 2.43, 95% confidence interval [CI] 2.12-2.79). Specifically, use of diclofenac (OR 3.09, 95% CI 1.96-4.87), naproxen (OR 2.64, 95% CI 2.13-3.28), celecoxib (OR 2.21, 95% CI 1.42-3.45), ibuprofen (OR 2.19, 95% CI 1.61-2.96) and rofecoxib (OR 1.83, 95% CI 1.24-2.70) alone, and combinations thereof (OR 2.64, 95% CI 1.59-4.39), were all associated with increased risk of spontaneous abortion. No dose-response effect was seen. Gestational exposure to any type or dosage of nonaspirin NSAIDs may increase the risk of spontaneous abortion. These drugs should be used with caution during pregnancy.

Risk of ST versus non-ST elevation myocardial infarction associated with non-steroidal anti-inflammatory drugs

ObjectiveThe objective of this study was to explore the association of non-steroidal anti-inflammatory drugs (NSAID) with ST-segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI).Design, Setting &...

Effects of non-steroidal anti-inflammatory drugs on the pharmacokinetics and elimination of aciclovir in rats

This study aims to investigate the effect of commonly used non-steroidal anti-inflammatory drugs (NSAIDs) on the pharmacokinetics and the renal elimination of aciclovir in rats. Pharmacokinetic parameters were determined following an intravenous administration of aciclovir (5 mg kg(-1)) to rats in the presence and absence of ketoprofen or naproxen (25 mg kg(-1)). Compared with the control (given aciclovir alone), pre-treatment with ketoprofen or naproxen 30 min before aciclovir administration significantly altered the pharmacokinetics of aciclovir. Renal clearance of aciclovir was reduced by approximately two fold in the presence of ketoprofen or naproxen. Consequently, the systemic exposure (AUC) to aciclovir in the rats pre-treated with ketoprofen or naproxen was significantly (P < 0.05) higher than that from the control group given aciclovir alone. Furthermore, the mean terminal plasma half-life of aciclovir was enhanced by 4-5 fold by pre-treatment with ketoprofen or naproxen. These results suggest that NSAIDs, such as ketoprofen and naproxen, are effective in altering the pharmacokinetics of aciclovir by inhibiting the organic anion transporter-mediated tubular secretion of aciclovir. Therefore, concomitant use of ketoprofen or naproxen with aciclovir should require close monitoring for clinical consequence of potential drug interaction.

Unusual Case of Acute Intestinal Obstruction

Chronic NSAID use can cause diaphragm like strictures within the bowel leading to intestinal obstruction. This rare entity is called diaphragm disease. Preoperative diagnosis is extremely difficult. NSAID related injury should be considered in patient with intestinal obstruction of unclear etiology. We hereby present an interesting case of a 46 years old lady with significant history of long term naproxen use, who presented with nausea, vomiting and abdominal pain. She was diagnosed with acute intestinal obstruction. She received a trial of conservative management which was unsuccessful. Exploratory laparotomy with segmental resection of ileum was done subsequently. Histopathology showed mucosal ulceration, inflammation and focal sub mucosal fibrosis consistent with diaphragm disease. Patient recovered well in the post operative period.KeywordsNSAIDS; Acute Intestinal Obstruction; Diaphragm Disease