misoprostol and Cardiovascular-Diseases

Non-steroidal antiinflammatory drugs (NSAIDs) are currently one of the most widely used drugs. The use of NSAIDs is associated with gastrointestinal toxicity, affecting both upper gastrointestinal tract (peptic ulcer disease) and lower gastrointestinal tract (NSAID-induced enteropathy). NSAIDs use has been associated with an increased risk of clinical relapse in inflammatory bowel disease patients. In this article, we review the upper and lower gastrointestinal toxicity of NSAIDs, with a focus on the risks and specific data of these drugs in inflammatory bowel disease patients, giving recommendations for its appropriate use in the clinical practice. Although evidence is scarce, short-term use of NSAIDs appears to be safe, and the data available suggest that selective COX-2 inhibitors are the safer option. NSAIDs should be avoided as long-term treatment or with high doses, especially in patients with active inflammation.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Cardiovascular Diseases; Cyclooxygenase 2 Inhibitors; Gastrointestinal Agents; Gastrointestinal Diseases; Humans; Inflammatory Bowel Diseases; Intestinal Mucosa; Misoprostol; Peptic Ulcer; Protective Agents; Recurrence; Risk Factors

A French Regional Pharmacovigilance Centre identified serious cardiovascular adverse effects linked to misoprostol and reported worldwide up to the end of 2012. Dozens of cases of myocardial infarction, angina and stroke had been reported, including after a single dose in gynaecology and obstetrics, for instance in elective abortion. This risk appears higher in smokers, women aged over 35 years, obese women, and after high-dose vaginal administration. The incidence is unknown. The bioavailability of misoprostol is higher with the vaginal than the oral route, especially when water is added to the tablet before vaginal administration. In practice, this risk must be taken into account, especially in women with risk factors for cardiovascular disease, or when using high doses or the vaginal route. When a high cardiovascular risk is identified, it is best to warn patients of the cardiac effects of this drug and advise them to consult a doctor if they experience chest tightness, or to propose an alternative method. Whenever possible, these women should not be alone when they take misoprostol.

Topics: Cardiovascular Diseases; Humans; Misoprostol; Myocardial Infarction; Stroke

There are numerous gastroprotective strategies recommended for reducing the risk of upper gastrointestinal (GI) complications in long-term users of nonsteroidal anti-inflammatory drugs (NSAIDs). The relative efficacy of the different strategies alone or in combination is uncertain.. We used the Manitoba Population Health Research Data Repository to perform a population-based matched case-control analysis. All NSAID users (nonselective and cyclooxygenase [COX]-2-specific) users admitted to the hospital with a primary diagnosis for an upper gastrointestinal complication were matched to NSAID-using controls in the community. We used conditional logistic regression analysis to determine the relative efficacy of different gastroprotective strategies (proton pump inhibitors [PPIs], COX-2 inhibitors, and low-dose/high-dose misoprostol) either alone or in combination and to adjust for multiple pertinent covariates.. A total of 1382 NSAID/COX-2 users with upper GI complications were matched to 33,957 age- and sex-matched controls. Cotherapy with PPIs or misoprostol or use of a COX-2 inhibitor all significantly reduced the risk of upper GI complications. COX-2 inhibitors were not statistically more likely to prevent upper GI complications than PPIs, although they were superior to low-dose misoprostol. The combination of COX-2 inhibitors with a PPI was associated with the greatest degree of upper GI complication risk reduction.. All of the commonly accepted gastroprotective strategies reduce the risk of upper GI complications in NSAID users, although the combination of COX-2 inhibitors with PPIs promotes the greatest risk reduction for NSAID-related upper GI complications. Celecoxib use specifically may be superior to the combination of nonselective NSAIDs with a PPI.

Topics: Age Distribution; Anti-Inflammatory Agents, Non-Steroidal; Anti-Ulcer Agents; Cardiovascular Diseases; Celecoxib; Cyclooxygenase 2 Inhibitors; Drug Therapy, Combination; Gastrointestinal Diseases; Humans; Incidence; Manitoba; Misoprostol; Prognosis; Proton Pump Inhibitors; Pyrazoles; Retrospective Studies; Risk Factors; Sex Distribution; Sulfonamides

Topics: Age Factors; Aged; Aged, 80 and over; Animals; Anti-Inflammatory Agents, Non-Steroidal; Anti-Ulcer Agents; Aspirin; Cardiovascular Diseases; Gastric Mucosa; Gastrointestinal Hemorrhage; Helicobacter Infections; Helicobacter pylori; Humans; Meta-Analysis as Topic; Middle Aged; Misoprostol; Peptic Ulcer; Peptic Ulcer Hemorrhage; Platelet Aggregation Inhibitors; Risk Factors

Topics: Anti-Inflammatory Agents, Non-Steroidal; Anti-Ulcer Agents; Cardiovascular Diseases; Celecoxib; Cyclooxygenase Inhibitors; Drug Interactions; Humans; Misoprostol; Pyrazoles; Stomach Diseases; Sulfonamides