Therapy with nonsteroidal, anti-inflammatory drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most frequently prescribed drugs worldwide. Their analgetic and, antiphlogistic effect results from an efficient inhibition of prostaglandin synthesis. The risk of side effects is remarkable. This concerns namely side effects in the gastrointestinal tract and the kidneys. The common NSAIDs inhibit both isoforms of the cyclooxygenase (COX). The analgetic and antiphlogistic effect results from the inhibition of COX-2,whereas the inhibition of COX-1 is responsible for the majority of side effects. If NSAID therapy is necessary, patients at risk should receive an effective prophylaxis, or be treated with COX-2-selective substances. The analgetic effects of COX-2 inhibitors are comparable to common NSAIDs, with a significant reduction of the gastrointestinal risks, except in cases of additional risk factors, e.g., low-dose ASS therapy, etc. In cases of renal impairment both substances should be used with caution, and subtle monitoring is necessary.