The Learning Blog

A review article published in the American Family Physician last December 15 gave several recommendations on the proper prescription and/or use of Non-steroidal Anti-inflammatory Drugs or NSAIDs. The key recommendations are as follows:

• Physicians should consider prescribing proton pump inhibitors (PPIs), double-dose histamine H₂ blockers, or misoprostol with NSAIDs for persons who must take NSAIDs, although they have had an NSAID-associated ulcer. Celecoxib may also be used alone in these patients, but this drug should be avoided in patients at increased risk for myocardial infarction. Women who might become pregnant should not take misoprostol. Two systematic reviews describe the use of NSAIDs in this setting for the prevention of endoscopic ulcers.
• For prevention of acute renal failure, NSAIDs should be avoided whenever possible in patients with preexisting kidney disease, congestive heart failure, or cirrhosis.
• For patients at risk for renal failure, and in those taking angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers, physicians should consider monitoring serum creatinine levels after prescribing treatment with NSAIDs.
• In patients taking anticoagulants, NSAIDs and aspirin should be avoided if possible. An increase in international normalized ratio (INR) should be expected if concurrent use of NSAIDs and anticoagulants is required. These patients should have appropriate INR monitoring, dosage adjustments of warfarin, and GI prophylaxis.
• In breast-feeding women, ibuprofen, indomethacin, and naproxen can be safely used.

Taken from Medscape CME

More than a month ago, the United States Food and Drug Administration (USFDA) Advisory Committee held a meeting in Maryland, USA in order to address the problem of liver injury related to the use of paracetamol (or acetaminophen) in both over-the-counter (OTC) and prescription drugs. More »

Image from veer.com

From theheart.org:

Possibly in the near future a patient with arthritis and heart disease might not be prescribed with one of the newer anti-arthritis drug called a COX-2 inhibitor such as celecoxib but with an older drug called naproxen.

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Low back pain

A 2007 Australian study concluded that a minimalist approach of advice and paracetamol to managing uncomplicated acute lower back pain is still better than taking NSAIDs and spinal manipulation.

I just recently received MedScape’s email listing their Top Ten Articles for 2008 for the Internal Medicine Specialty. Click on the numbered headings for more information on the particular articles. More »