Adverse effects of nonsteroidal anti-inflammatory drugs on renal function

Article Abstract:

Patients with congestive heart failure, cirrhosis of the liver, and renal insufficiency need to synthesize prostaglandins, which cause blood vessels to dilate and allow fluids to pass through the kidneys. Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit the synthesis of prostaglandins. When patients with these disorders are given NSAIDs, they are at risk for developing ischemia, or inadequate blood supply, in the kidneys due to vascular constriction; this can lead to kidney deterioration. Many clinicians think that the ischemic effects of NSAIDs take time to develop, and wait several weeks to test the renal function of patients who are at risk of kidney problems when taking NSAIDs. However, studies show that some NSAIDs, such as ibuprofen, are short-acting and may inhibit prostaglandin synthesis within 8 to 12 hours. The kidney function of patients who take short-acting NSAIDs should be monitored within days. Large doses of ibuprofen have been associated with negative renal effects, but doses of ibuprofen that can be obtained over-the-counter (without a prescription) can also cause renal ischemia. It has been suggested that over-the-counter ibuprofen should contain a warning that patients with serious conditions should consult their doctor before use. However, early monitoring of longer-acting NSAIDS, such as piroxicam and sulindac, is not sufficient; monitoring for these NSAIDS must be continued for longer periods of time. The costs of monitoring the renal functions of patients who are receiving NSAIDS could be staggering. Epidemiological studies are needed to determine the risks for developing kidney complications with NSAIDS. Guidelines are needed for clinicians to monitor certain patients taking NSAIDS. In addition, the public must be educated on the potential hazards of the use of NSAIDS if certain other medical conditions exist. (Consumer Summary produced by Reliance Medical Information, Inc.)

editorial

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Improving medication use for older adults: an integrated research agenda

Article Abstract:

Effective health care is a core determinant of successful aging, and medications are one of the most important therapeutic tools of health care providers. Most older adults use at least one prescription drug. Costs for these drugs are a substantial out-of-pocket expense for Medicare beneficiaries, and low-income older adults must weigh these costs against those of other basic needs. Although medications bring welcome relief to millions of elderly persons with age-related conditions, adverse drug events are an important cause of illness and death in these patients. Thus, the appropriate, cost-effective use of medication is central to successful aging. Despite increasing attention to geriatric pharmacotherapy, there is an enormous need for additional research to improve the use of medications among older adults. The necessary research agenda encompasses much more than just the discovery of new drugs; better use of the current pharmacopeia has great potential to improve the lives of older adults. We review four domains of pharmaceutical research: drug discovery and delivery, drug efficacy and safety, pharmacoepidemiology and drug policy, and improved access to and use of drugs. These domains encompass both the pre- and postmarketing phases of drug research. Premarketing research currently has greater magnitude and a better infrastructure than postmarketing research, yet issues arising in the two phases of research are equally important to the health and safety of older adults. A national, federally supported pharmaceutical database could greatly enhance the infrastructure of postmarketing research. However, many major improvements in medication use among older adults will also depend on closing the gap between knowledge and practice and increasing the ability of older adults to manage their medications.

Care and treatment, Aged, Elderly, Geriatric pharmacology, Author Abstract

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Renal effects of ibuprofen, piroxicam, and sulindac in patients with asymptomatic renal failure

Article Abstract:

Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit the synthesis of prostaglandins, which cause dilation of blood vessels. When patients with asymptomatic, mild but chronic renal failure are given NSAIDs, they are at risk for developing ischemia (inadequate blood supply) in the kidneys due to vascular constriction; this can lead to deterioration of the kidneys. The effects of the NSAIDs ibuprofen, piroxicam, and sulindac were evaluated in patients with asymptomatic, mild but chronic renal failure. It was found that the use of ibuprofen (Motrin) for a brief course, less than eight days, resulted in acute renal failure. This adverse effect occurred with large doses of ibuprofen, but it can also occur with doses that are obtainable without a prescription (over-the-counter). Patients with mild renal impairment, especially that which is undiagnosed, may develop kidney problems when taking over-the-counter ibuprofen. Patients given piroxicam and sulindac for 11 days showed no signs of renal problems. Further study is needed to evaluate the risks of taking piroxicam and sulindac for longer periods of time. These drugs may accumulate in the body. (Consumer Summary produced by Reliance Medical Information, Inc.)

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