Complications
Long-term use of NSAIDs can cause gastric irritation, peptic ulceration, and upper gastrointestinal bleeding in some patients. This risk can be decreased with the use of proton-pump inhibitors (PPIs). If symptoms occur, NSAIDs should be stopped and the patient evaluated for complications of gastrointestinal ulceration.
NSAIDs decrease the production of renal prostaglandins, which act as vasodilators to maintain renal perfusion pressure. In a healthy person these prostaglandins have only a minor role, but they become progressively more important in people with glomerular disease and renal insufficiency. A resulting fall in haemodynamic pressure can cause acute renal failure.
NSAIDs may also cause acute interstitial nephritis as a result of decreased prostaglandin synthesis.
Elevations of serum aminotransferases (transaminases) are commonly associated with NSAID use; however, liver failure is rare. Diclofenac is associated with higher rates of hepatotoxicity than other NSAIDs.[53]
There is consistent evidence of an association between NSAID use and increased blood pressure in both normotensive and hypertensive adults.[54] In normotensive, otherwise healthy adults who require a short course of an NSAID, the advantages of treatment are likely to outweigh the potential for what appears to be, on average, a minor blood pressure elevation. In those with existing hypertension the magnitude of the blood pressure increase is less predictable and may vary with age, baseline blood pressure, type of NSAID and concurrent antihypertensive therapy.[55]
There is evidence to indicate that increased CV risk is a class effect of NSAIDs.[56][57] The level of risk varies between drugs and with dose used.[57] Adequate monitoring for signs and symptoms of adverse effects with proper patient education are required to increase patient safety during NSAID therapy. The duration of NSAID treatment should be limited as much as the clinical situation allows and only the minimal effective dose should be used.
Overuse of paracetamol can potentially lead to liver damage, especially when exceeding the recommended dosage or using it regularly for an extended period. Similar to non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol may also increase blood pressure.[55]
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