Anti-inflammatory and antipyretic analgesics and drugs used in gout

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Book Chapter

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In regard to the adverse effects of analgesic and anti-inflammatory drugs, focus remains on cardiovascular safety of nonsteroidal anti-inflammatory drugs (NSAIDs). Two nested case-control studies evaluated NSAIDs and the risk for acute myocardial infarction (AMI) and ischemic stroke (IS) in new NSAID users. Both studies identified multiple individual NSAIDs with an increased risk of AMI or IS in current users compared to past users. Ketorolac had the highest risk for both events. In treatment of advanced non-small-cell lung cancer, celecoxib may be added to systemic therapy. A systematic review found that when examining grade III or higher toxicities, although there was an increased risk of leukopenia, thrombocytopenia, and rash, there was not a significant difference in risk of thrombosis/embolism or myocardial ischemia with celecoxib compared to treatment without celecoxib. A retrospective cohort study of patients ≥ 65 years old reported that celecoxib users had fewer gastrointestinal bleeding events than traditional NSAID users. However, celecoxib use of ≥ 120 days was associated with increased cardiovascular and renal risk. Regarding therapeutics of gout, two large studies focused on the safety of febuxostat compared to allopurinol. The CARES trial examined gout patients with coexisting cardiovascular disease and reported that febuxostat-treated patients were at a higher risk for cardiovascular death and death from any cause relative to patients receiving allopurinol. However, a cohort study of Medicare patients with gout and including those without cardiovascular disease did not find significant differences between febuxostat- and allopurinol-treated patients in regard to risk for cardiovascular events or all-cause death.

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