Toxicity of NSAIDs at Therapeutic Doses

NSAIDs are relatively safe drugs that have a number of well-documented side effects at therapeutic doses. Given the huge number of NSAID prescriptions written by emergency department physicians, it is important to be aware of common side effects. Morbidity and death from renal insufficiency and GI bleeding with chronic NSAID use far overshadow that of acute NSAID overdose. Other organ systems that may show toxicity at therapeutic doses include the central nervous system (CNS), cardiovascular, respiratory, hepatic, and dermatologic. It is generally believed that indomethacin and the long-acting agents phenylbutazone and piroxicam are responsible for a greater proportion of side effects, and that the propionic acid agents such as ibuprofen are responsible for fewer side effects.

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