Choosing nonselective NSAIDs and selective COX-2 inhibitors in the elderly: A clinical use pathway

Martin J. Stillman, M T Stillman

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

The literature has well established that nonsteroidal anti-inflammatory drugs (NSAIDs) are very effective in treating pain and inflammation, but these drugs are associated with significant gastrointestinal (GI)toxicity. This is especially true in the elderly patient population. Selective cyclooxygenase-2 (COX-2) inhibitors (cosibs) were developed to decrease the Incidence of GI adverse events. Nevertheless, recent concerns regarding coxibs and their association with adverse cardiovascular events have led physicians to re-examine the appropriate use of all NSAIDs. Part 1 of this two-part article reviews essential data related to adverse GI events to help physicians select appropriate patients to receive nonselective NSAIDs or coxibs. Other considerations, such as the benefits of proton pump inhibitors (PPIs) and the mitigating effects of concurrent aspirin use, are also discussed. Our clinical use pathway or algorithm will frame the discussion and guide clinicians through what has become a difficult decision in daily practice.

Original languageEnglish (US)
Pages (from-to)26-34
Number of pages9
JournalGeriatrics
Volume62
Issue number2
StatePublished - Feb 1 2007

Keywords

  • Aspirin
  • Clinical use pathway
  • Gastrointestinal adverse events
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Proton pump inhibitors (PPIs)
  • Selective COX-2 inhibitors (coxibs)

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