Current state of therapy for pain and inflammation

Table 1 Guidelines for NSAID use

	NSAID alone	NSAID + PPI	COX-2	COX-2 + PPI
Appropriate	Age <65 years, no aspirin and no previous gastrointestinal event	On aspirin Previous gastrointestinal event	On aspirin and no previous gastrointestinal event Not on aspirin and previous gastrointestinal event	Previous gastrointestinal event and on aspirin On aspirin and steroids/warfarin
Inappropriate	Previous gastrointestinal event On aspirin, steroids, or warfarin	Age <65 years, not on aspirin and no previous gastrointestinal event	-	Not on aspirin and no previous gastrointestinal event Age <65 years, on aspirin but no previous gastrointestinal event Age <65 years, previous uncomplicated gastrointestinal event and not on aspirin, steroids, or warfarin

Shown are guidelines for nonsteroidal anti-inflammatory drug (NSAID) use prior to rofecoxib withdrawal [9]. COX, cyclo-oxygenase; PPI, proton pump inhibitor. Reproduced with permission from [9].

ISSN: 1478-6362