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Toxic Effects of NSAIDS

Non-steroidal anti-inflammatory agents (NSAID) reduce pain and inflammation. They are available over the counter or by prescription. Toxic effects are the result of acute ingestion (overdose) or chronic, long-term therapy. The Arthritis, Rheumatism, and Aging Medical Information System estimates that each year more than 100,000 hospitalizations and 16,000 deaths in the U.S. are linked to NSAID-related complications. The severity of the symptoms depends on drug, dosage and timing of ingestion. Multiple systems can be affected.

  1. Gastrointestinal and Hepatic Effects

    • Gastrointestinal symptoms typically predominate, both with acute and with chronic ingestion. Nausea, vomiting and diarrhea are commonly seen in acute ingestion, because of the irritation of stomach and bowel lining. Liver dysfunction with tenderness and jaundice occurs following severe toxicity. Chronic therapy may result in ulceration and bleeding.

      Elderly patients and alcohol consumers are especially at risk for complications. If you are in one of these categories, exercise caution when taking NSAIDS for chronic arthritis or acute musculoskeletal injury. Discuss this with your health care provider. Even at nontoxic levels, NSAIDs can damage the gastrointestinal tract.

    Renal Effects

    • Kidney effects are the second most common problem associated with NSAID use. Individuals with pre-existent kidney disorders are more vulnerable. A type of inflammation that affects the spaces between renal tubules (interstitial nephritis) occurs both with acute and chronic use. Salt and water retention, acute renal failure and tissue death in the area of renal papillae (papillary necrosis) can accompany overdose.

    Central Nervous System Effects

    • Toxicity of NSAID (often ibuprofen and naproxen) is associated with nervous system symptoms: changes in mood and cognitive abilities, drowsiness, headache, seizures, hallucinations and meningitis.

    Blood and Cardiovascular System Effects

    • Major acute NSAID toxicity leads to rapid heartbeats and even cardiac or respiratory arrest.

      These drugs also can exacerbate hypertension and heart failure. Some prescription NSAIDs, such as Vioxx, were removed from the market because of the risk of stroke and heart attacks. Celebrex, however, is still available in the United States.

      Concomitant use of another NSAID can annihilate the beneficial cardiovascular effect of aspirin.

      Blood complications are rare and include decreased numbers of platelets (blood cells involved in coagulation), anemia and reduced numbers of white blood cells. Even at nontoxic levels, however, coagulation can be affected.

    Skin Reactions

    • Skin irritation can be present with minor acute toxicity. A serious condition called Stevens-Johnson syndrome occurs rarely; it is characterized by painful rash and blisters, with shedding of the skin's top layer.

    Drug Interactions

    • Significant toxicity can result from interactions between NSAIDs and lithium, oral anticoagulants, oral hypoglycemic medications, phenytoin, digoxin or aminoglycoside antibiotics.

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