Presentation
The case of a 61-year-old man who gradually developed similar inflammatory changes in the ascending colon during prolonged intake of a slow-release form of diclofenac is presented, and the literature on nonsteroidal antiinflammatory drug-induced intestinal [ncbi.nlm.nih.gov]
Entire Body System
- Anemia
Small intestine inflammation and bleeding (enteropathy) due to NSAIDs must be considered in the evaluation of anemia in patients with arthritis. [ncbi.nlm.nih.gov]
Key terms Anemia — A lack of hemoglobin—the compound in blood that carries oxygen from the lungs throughout the body and brings waste carbon dioxide from the cells to the lungs, where it is released. [medical-dictionary.thefreedictionary.com]
[…] development of anemia [40]. [arthritis-research.biomedcentral.com]
[…] are currently taking any other medications (including over-the-counter medications) and/or herbal or dietary supplements If you are pregnant, planning to become pregnant, or are breast-feeding If you have problems taking any medications If you have anemia [my.clevelandclinic.org]
- Congestive Heart Failure
Other heart-related side effects such as high blood pressure, congestive heart failure, and palpitations have also been reported. [drugs.com]
NSAIDs associated with increased risk of congestive heart failure in elderly patients taking diuretics. Arch Intern Med 1998; 158: 1108–1112. 6. Page J, Henry D. [journals.lww.com]
Heart failure Several large cohort studies have looked at the association between heart failure and NSAID use. [futuremedicine.com]
heart failure Asthma that gets worse when taking aspirin Pregnancy in the third trimester History of stroke or heart attack If you are 65 years of age or older Simultaneous use with certain medications such as warfarin (Coumadin®), clopidogrel (Plavix [my.clevelandclinic.org]
- Fatigue
In addition, some people taking NSAIDs have experienced asthma attacks, bleeding, fatigue, headache, insomnia, low neutrophil levels, urticaria (hives), vertigo and seizures. [drugs.com]
Common side effects of prescription NSAIDs may include: dizziness headache nausea diarrhea excess gas constipation extreme weakness or fatigue dry mouth. Serious, but rare, side effects of prescription NSAIDs may include: Allergic reaction. [familydoctor.org]
Symptoms include: headache, neck pain, neck and shoulder stiffness, shoulder pain, fatigue, dizziness, jaw pain, arm pain, weakness of the arm(s), visual disturbances, and tinnitus. [medicinenet.com]
[…] urine Severe stomach pain Blood or material that looks like coffee grounds in vomit (bleeding may occur without warning symptoms like pain) Blurred vision Wheezing, trouble breathing, or unusual cough Chest pain, rapid heartbeat, palpitations Acute fatigue [my.clevelandclinic.org]
Gastrointestinal
- Nausea
A 44-year-old-male visited our out-patient department with symptoms of nausea, vomiting, and general weakness that had developed over the previous 2 weeks. He had history of medication, nonsteroidal anti-inflammatory drugs. [ncbi.nlm.nih.gov]
Common side effects are nausea, vomiting, diarrhea, constipation, decreased appetite, rash, dizziness, headache, and drowsiness. [medicinenet.com]
GIT: Aspirin and released salicylic acid irritate gastric mucosa, cause epigastric distress, nausea and vomiting. It also stimulates CTZ. 7. Urate excretion: Aspirin in high dose reduces renal tubular excretion of urate 17 18. 8. [slideshare.net]
NSAIDs can increase the risk of developing nausea, an upset stomach, or an ulcer. They also may interfere with kidney function. [orthoinfo.aaos.org]
- Vomiting
A 44-year-old-male visited our out-patient department with symptoms of nausea, vomiting, and general weakness that had developed over the previous 2 weeks. He had history of medication, nonsteroidal anti-inflammatory drugs. [ncbi.nlm.nih.gov]
Common side effects are nausea, vomiting, diarrhea, constipation, decreased appetite, rash, dizziness, headache, and drowsiness. [medicinenet.com]
Serious side effects that require immediate medical attention include: ringing in your ears blurry vision rash, hives, and itching fluid retention blood in your urine or stools vomiting and blood in your vomit severe stomach pain chest pain rapid heartbeat [healthline.com]
Gastrointestinal side effects that may occur include bloating, diarrhea, constipation, irritation of the lining of the stomach, nausea or vomiting. NSAIDs may also affect kidney function and reduce how quickly blood flows through the kidneys. [drugs.com]
- Constipation
The most common treatment-related adverse events for tramadol/APAP were somnolence (6.5%), nausea (4.6%), and constipation (3.3%). Mean tramadol/APAP dose was 4.1 tablets (154 mg tramadol/ 1332 mg APAP). [ncbi.nlm.nih.gov]
Gastrointestinal side effects that may occur include bloating, diarrhea, constipation, irritation of the lining of the stomach, nausea or vomiting. NSAIDs may also affect kidney function and reduce how quickly blood flows through the kidneys. [drugs.com]
The most common side effects are: vomiting, nausea, constipation, diarrhea, reduced appetite, headache, dizziness, rash, and drowsiness. NSAIDs also may cause swelling of the arms and legs due to the retention of fluid from their renal effects. [rxlist.com]
Constipations disturb blood circulation. Irrational diet: lack of vitamins, eating fast-food without any beverage can also lead to varicose veins among young women. [varicose-default.zcpa.info]
- Abdominal Pain
Advanced Search: • Use “ “ for phrases o [ “pediatric abdominal pain” ] • Use – to remove results with certain terms o [ “abdominal pain” –pediatric ] • Use OR to account for alternate terms o [teenager OR adolescent ] [msdmanuals.com]
He reported a history of recurrent episodes of colic abdominal pain during the past 25 years; he underwent three surgical operations for this condition. [ncbi.nlm.nih.gov]
Most NSAID ingestions are asymptomatic or are associated with only minimal gastrointestinal (GI) symptoms, such as nausea, emesis, abdominal pain, and GI bleeding. Hepatic injury resulting in increased liver enzymes and liver failure can occur. [pedsinreview.aappublications.org]
COX-2 inhibitors are not without side effects, which can include abdominal pain, nausea, and indigestion. Antacids or a fatty meal can limit the body's ability to absorb and use COX-2 inhibitors, so do not take them together. [orthoinfo.aaos.org]
- Dyspepsia
Of a group of 4,256 hospitalized patients receiving therapy with NSAIDs, 221 patients with persistent dyspepsia underwent endoscopic examination of the upper segment of the gastrointestinal tract. [ncbi.nlm.nih.gov]
Though tolerability of celecoxib is better than traditional NSAIDs, still abdominal pain, dyspepsia and mild diarrhoea are the common side effects. [slideshare.net]
When used in this way, the most frequent side effects are dyspepsia, diarrhea and abdominal pain (15). It is particularly important for the clinician to know which NSAIDs present the greatest gastrointestinal complication risk. [scielo.isciii.es]
They cause side effects including gastrointestinal (GI) disorders (from minor dyspepsia through to major ulcers, bleeding and perforation), kidney effects and cardiovascular effects. [jpharmacol.com]
They can include an array of symptoms and manifestations varying in severity from simple dyspepsia with pyrosis to fully developed gastric or intestinal ulcer. [intechopen.com]
Cardiovascular
- Hypertension
There was a statistically significant relationship between NSAID usage and having hypertension (p = 0.013, OR 2.064, 95% CI 1.16 - 3.65). 78 of the antihypertensive and 88% of the analgesic/NSAIDs users explained the purpose of the drug usage properly [ncbi.nlm.nih.gov]
The risk associated with NSAIDs was higher when the attributed etiology of heart failure was hypertension. [journals.lww.com]
Results Whenever possible, a NSAID should be avoided in patients with treatment-resistant hypertension, high risk of cardiovascular disease and severe chronic kidney disease (CKD). [gut.bmj.com]
Non-narcotic analgesic dose and risk of incident hypertension in US women. Hypertension 2005;46:500-7. 30. Dedier J, Stampfer MJ, Hankinson SE, Willett WC, Speizer FE, Curhan GC. Nonnarcotic analgesic use and the risk of hypertension in US women. [scielo.isciii.es]
- Hypotension
[…] from colchicine, three from ibuprofen, and one from naproxen. [1] AAPCC NPDS outcomes are defined as follows: None Minor: Minimally bothersome with rapid resolution (eg, self-limited GI symptoms, drowsiness, skin irritation, sinus tachycardia without hypotension [emedicine.medscape.com]
Orthostatic Hypotension Orthostatic hypotension symptoms include: LightheadednessWeaknessBlurred vision Syncope or passing out Causes of orthostatic hypotension include: Dehydration, Anemia, Medication Blood loss Low blood pressure Heat related illnesses [medicinenet.com]
In patients with diminished kidney perfusion (hypotension, cirrhosis, congestive heart failure, diuretic use or blood loss), the kidneys increase prostaglandin synthesis to raise the filtration rate and secure an adequate renal flow. [scielo.isciii.es]
Eyes
- Blurred Vision
Very rare reactions (occuring in less than 1 in 100 people) include: Inflammation of the bladder; Nephrotic syndrome; Acute renal failure; Photosensitivity; Hepatitis (inflammation of the liver); Aseptic meningitis; Blurred vision; Tinnitus. [healthengine.com.au]
Lastly, neurologic toxicity can present with drowsiness, confusion, nystagmus, blurred vision, diplopia, headache, and tinnitus.[20] Enhancing Healthcare Team Outcomes The general public widely uses NSAIDs because of their wide range of commonly encountered [ncbi.nlm.nih.gov]
vision Wheezing, trouble breathing, or unusual cough Chest pain, rapid heartbeat, palpitations Acute fatigue, flu -like symptoms Jaundice Photosensitivity (greater sensitivity to light) Change in strength on one side is greater than the other, trouble [my.clevelandclinic.org]
Blurred vision or other vision problems also are possible side effects. For these reasons, anyone who takes these drugs should not drive, use machines or do anything else that might be dangerous until they have found out how the drugs affect them. [medical-dictionary.thefreedictionary.com]
Ears
- Tinnitus
Decreased hearing or ringing in the ears (also called tinnitus). Jaundice (the yellowing of the skin and the whites of the eyes). Abdominal cramping. Heartburn. Indigestion. [familydoctor.org]
The side effects of aspirin use include upset stomach, heartburn, nausea, tinnitus (ringing in the ears), headache, and diaorrhea. Aspirin has an effect on the blood clotting system, which means that bleeding within the damaged tissue may increase. [physioroom.com]
Very rare reactions (occuring in less than 1 in 100 people) include: Inflammation of the bladder; Nephrotic syndrome; Acute renal failure; Photosensitivity; Hepatitis (inflammation of the liver); Aseptic meningitis; Blurred vision; Tinnitus. [healthengine.com.au]
Lastly, neurologic toxicity can present with drowsiness, confusion, nystagmus, blurred vision, diplopia, headache, and tinnitus.[20] Enhancing Healthcare Team Outcomes The general public widely uses NSAIDs because of their wide range of commonly encountered [ncbi.nlm.nih.gov]
CNS side effects include headache, dizziness, blurring of vision, tinnitus and depression. Rashes, itching and other hypersensitivity phenomena are infrequent. They are not to be prescribed to pregnant woman and should be avoided in peptic ulcer [slideshare.net]
Skin
- Urticaria
Studies, review articles, and commentaries on aspirin-induced asthma and aspirin- or NSAID-induced urticaria/angioedema were included in the review. [ncbi.nlm.nih.gov]
There are four presentations recognised: patients with an atopic tendency – urticaria is the usual presentation, rarely involving the airways. 80% of intolerant-to- NSAID patients are atopic. in non-atopics, urticaria and anaphylactic reactions, or urticaria [dermnetnz.org]
Arbitrarily, we use 1/10th of the desired dose in cases of urticaria, and dose at approximate 2-hour intervals. [aaaai.org]
- Photosensitivity
Photosensitivity to ketoprofen: mechanisms and pharmacoepidemiological data. Drug Safety 2000; 22: 339-349. Dermatology. Ed. Bolognia, J et al. 2nd edition 2007. Mosby Cousin F, Philips K, Favier B, Bienvenu J, Nicolas JF. Drug-induced urticaria. [dermnetnz.org]
[…] causing very high blood pressure requiring emergency treatment Nonnucleoside reverse transcriptase inhibitors Increases metabolism of these drugs, reducing their efficacy Oral contraceptives Increases metabolism of these drugs, reducing their efficacy Photosensitizing [msdmanuals.com]
Very rare reactions (occuring in less than 1 in 100 people) include: Inflammation of the bladder; Nephrotic syndrome; Acute renal failure; Photosensitivity; Hepatitis (inflammation of the liver); Aseptic meningitis; Blurred vision; Tinnitus. [healthengine.com.au]
- Skin Rash
All NSAIDs also carry the risk of potential skin reactions. Patients should be alert for symptoms such as skin reddening, rash or blisters. [fda.gov]
rash skin irritation, reddening, itching or rash (if skin products are used, such as a cream). [betterhealth.vic.gov.au]
Epigastric distress is complained, but gut bleeding is not significant. Skin rashes, dizziness and other CNS manifestations have occurred. Haemolytic anaemia is a rare but serious complication. Pharmacokinetics: Oral absorption is slow but almost [slideshare.net]
Neurologic
- Nystagmus
Lastly, neurologic toxicity can present with drowsiness, confusion, nystagmus, blurred vision, diplopia, headache, and tinnitus.[20] Enhancing Healthcare Team Outcomes The general public widely uses NSAIDs because of their wide range of commonly encountered [ncbi.nlm.nih.gov]
Urogenital
- Renal Insufficiency
Miscellaneous adverse effects and contraindications May decrease the glomerular filtration rate, particularly in patients with renal insufficiency. Occasionally produce mild hepatitis Prolong bleeding time. Aspirin irreversibly inhibits platelet [slideshare.net]
Treatment
[…] ability in RA, and 60-80% as great as NSAID treatment in reduction in tender joint counts in RA. [ncbi.nlm.nih.gov]
Prognosis
Since there is no proven treatment for the GIN yet, we can carefully suggest that moderate to high dosage corticosteroid can be helpful for prognosis in case of acute granulomatous interstitial nephritis of patients with AKI. [ncbi.nlm.nih.gov]
Usually, the prognosis for peripheral neuropathy is good if the cause can be successfully treated or prevented. Ankle Pain (Tendinitis) Ankle pain is commonly due to a sprain or tendinitis. [medicinenet.com]
Etiology
[…] effects Cell Survival/drug effects Cells, Cultured DNA Replication/drug effects Disease Models, Animal Female Humans Ibuprofen/administration & dosage* Indomethacin/administration & dosage* Ketorolac/administration & dosage* Male Ossification, Heterotopic/etiology [ncbi.nlm.nih.gov]
The risk associated with NSAIDs was higher when the attributed etiology of heart failure was hypertension. [journals.lww.com]
Epidemiology
Abstract The authors performed a systematic review to summarize the epidemiologic evidence on the association between use of nonsteroidal antiinflammatory drugs (NSAIDs) and the risk of dementia. [ncbi.nlm.nih.gov]
Pathophysiology
Consequently, an appreciation for the risk factors and pathophysiology of NSAID-induced renal function abnormalities is required for optimal use of these drugs. [ncbi.nlm.nih.gov]
The pathophysiology of aseptic meningitis is uncertain, and there are probably multiple mechanisms involved. The condition has been observed in all age-groups and can occur after the use of a wide spectrum of pharmacologic agents. [mdmag.com]
Pathophysiology More than 20 drugs fall under the category of NSAID. [emedicine.medscape.com]
In: Pharmacotherapy: a Pathophysiologic Approach. Dipiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM (Eds). McGraw-Hill/Appleton & Lange, OH, USA (2008).Google Scholar 69 Risser A, Donovan D, Heintzman J, Page T. [futuremedicine.com]
Prevention
STUDY DESIGN: Data were from the National Birth Defects Prevention Study, a multisite population-based, case-control study of risk factors for birth defects. [ncbi.nlm.nih.gov]
Low doses of aspirin, less than 325 mg/day, taken for preventing heart attacks and strokes, also are associated with stomach and intestinal adverse reactions; however, the heart attack and stroke preventing actions of the low doses may compensate for [rxlist.com]