NSAIDs: gastroprotection or selective COX-2 inhibitor?

被引:20
|
作者
Dickman, A [1 ]
Ellershaw, J [1 ]
机构
[1] Marie Curie Ctr, Liverpool L25 8QA, Merseyside, England
关键词
celecoxib; COX-1; COX-2; gastroprotection; nonsteroidal anti-inflammatory drug; palliative care; proton pump inhibitor; rofecoxib;
D O I
10.1191/0269216304pm894fd
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Conventional nonsteroidal anti-inflammatory drugs (NSAIDs) are effective adjuvant analgesics commonly encountered in palliative care. However, these drugs are associated with adverse effects that are primarily due to gastrointestinal toxicity, with resultant serious complications such as gastroduodenal perforations, ulcers and bleeds. This toxicity has been attributed to inhibition of cyclooxygenase-1 (COX-1). Factors known to increase this risk of toxicity include age above 65 years, classification of NSAID in terms of CCX-1/COX-2 selectivity, previous history of complications and coadministration of aspirin, anticoagulants and corticosteroids. Selective inhibitors of cyclooxygenase-2 (COX-2) were developed in an attempt to reduce this association; trials to date confirm that these drugs do indeed have reduced incidence of gastroduodenal toxicity. Prior to the introduction of the COX-2 selective inhibitors, patients at high risk were often coprescribed a gastroprotective agent (such as misoprostol or a proton pump inhibitor) with a conventional NSAID. This review discusses the merits of both options and devises a treatment strategy for the safe and cost-effective use of these drugs in the palliative care population.
引用
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页码:275 / 286
页数:12
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