Published: December 2010

Reducing the risk of GI reactions with NSAIDs and/or COX-2 inhibitors

Prescriber Update 31(4): 32
December 2010

Non-selective non-steroidal anti-inflammatory drugs (NSAIDs) have varying degrees of anti­inflammatory, analgesic and antipyretic effects. These effects are related to the inhibition of the cyclo-oxygenase isoenzymes COX-1 or COX-2 that are involved in the production of prostaglandins and thromboxanes.1

Gastrointestinal (GI) side effects occur commonly with all NSAIDs, including selective COX-2 inhibitors. These events are generally considered to be mediated by inhibition of COX-1, responsible for synthesis of the prostaglandins that inhibit acid secretion.1 COX-2 selectivity should theoretically reduce the risk of GI adverse events; however studies have shown that COX-2 inhibitors still have a low affinity for COX-1.2

An analysis of reports sent to the Centre for Adverse Reactions (CARM) shows most patients experiencing GI adverse reactions with NSAIDs or COX-2 inhibitors had other risk factors for these events. Risk factors include: age greater than 65 years, history of peptic ulcer or gastrointestinal bleeding, previous gastric irritation with NSAID use, use of multiple NSAIDs or COX-2 inhibitors, and concomitant use of corticosteroids, anticoagulants and SSRIs.

For all patients requiring treatment with either a non-selective NSAID or COX-2 inhibitor, the extent and severity of gastrointestinal events can be reduced by:

Healthcare professionals are encouraged to keep up-to-date with current prescribing information in product data sheets and applicable guidelines.

  1. Rang H., Dale M. and Ritter J. 1999. Pharmacology (4th Ed.) Edinburgh: Churchill Livingstone.
  2. Pfizer New Zealand Ltd. 5 June 2009. Celebrex (celecoxib) data sheet.