Understanding NSAIDs: from aspirin to COX-2.
Understanding NSAIDs: from aspirin to COX-2.
复制标题
DOI：
10.1016/s1098-3597(01)90069-9
复制
发表时间：
2001-01-01
期刊：
影响因子：
--
通讯作者：
Green, G A
中科院分区：
文献类型：
--
作者：
Green, G A
仅在美国，非类固醇抗炎药(NSAIDs)每年就有7000万张处方和300亿种非处方药(OTC)销售。尽管我们熟悉这些药物，但非甾体抗炎药充满了悖论，给医学界带来了巨大的挑战。尽管非甾体抗炎药是最古老的药物之一，但新的配方继续进入市场。一些配方奶粉足够安全，可以在非处方药上销售，用于发烧的婴儿，而另一些配方奶粉只能作为处方药使用，是医源性反应、住院和死亡的主要原因。医生面临的选择是开出成本更低、年龄更大的非甾体抗炎药，还是开出更昂贵但可能更安全的非甾体抗炎药。非甾体抗炎药的使用明显增加。造成这一增长的因素是非处方药制剂的可获得性和人口老龄化，并伴随着骨关节炎的增加。非甾体抗炎药受欢迎的一个迹象是，在1999年推出两种新的环氧合酶-2(COX-2)选择性抑制剂后，这些药物立即成为美国最常用的新药。这篇文章将使从业者熟悉各种类型的非类固醇抗炎药，包括较新的COX-2配方，它们的作用机制，以及潜在的不良反应和疗效。尽管大多数从业者都知道非甾体抗炎药的适应症，但研究仍在继续探索非传统应用。正在创建一个新的框架，允许将新的药物添加到非类固醇抗炎药类别中。
Nonsteroidal anti-inflammatory drugs (NSAIDs) annually account for 70 million prescriptions and 30 billion over-the-counter (OTC) medications sold in the United States alone. Despite our familiarity with these drugs, NSAIDs are full of paradoxes that pose significant challenges for the medical community. Although NSAIDs are among the oldest of drugs, new formulations continue to come to market. Some formulas are safe enough to be sold OTC for use in infants with fever, while others are available only as a prescription medication and are a leading cause of iatrogenic reactions, hospitalizations, and death. Physicians face the choice of prescribing lower cost, older NSAIDs versus the more expensive but potentially safer ones. The use of NSAIDs is clearly increasing. Factors contributing to this increase are the availability of OTC preparations and the aging of the population with a concomitant increase in osteoarthritis. One indication of the popularity of NSAIDs is that following the introduction of 2 new cyclooxygenase-2 (COX-2) selective inhibitors in 1999, these drugs immediately became the most frequently prescribed new drugs in the United States. This article will familiarize the practitioner with the various types of NSAIDs, including the newer COX-2 formulations, their mechanism of action, and potential adverse reactions and efficacy. Although most practitioners are aware of the indications for NSAIDs, research is continuing to explore nontraditional applications. A new framework is being created that will allow new additions to the NSAID class of medications.