More than a dozen
NSAIDs are commercially available in the United States.
Diclofenac may not be as effective for
dysmenorrhea. Although most are equally efficacious,
indomethacin is the preferred agent for
hemicrania continua and
chronic paroxysmal hemicrania. Although all
NSAIDs should theoretically be beneficial in
gout, the greatest experience is with
indomethacin.
Sulindac may be the preferred agent for
diabetic neuropathy.
Fenoprofen appears to be the most offensive
NSAID in terms of nephrotoxicity.
NSAIDs may antagonize
antihypertensive therapy, although this effect may not persist beyond 1 month. Generally, use of
NSAIDs in pediatric patients is limited to
naproxen and
tolmetin. Concomitant
therapy with
methotrexate,
lithium, and AZT should be approached with caution.
NSAIDs have similar propensities to cause gastrointestinal side effects.
Sucralfate has consistently proved beneficial as cytoprotective
therapy for use with
NSAIDs without impairing absorption of the
NSAID,
NSAIDs generally should be avoided prior to surgery, although
sulindac or nonacetylated
salicylates have a negligible effect on platelet function and may be used if continued
NSAID therapy is required. Hepatotoxicity, although rare with
NSAIDs, is most common with
phenylbutazone and least common with the
fenamates.