General tolerability and use of nonsteroidal anti-inflammatory drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are generally well tolerated medications but are associated with several adverse effects that may occur as a result of the physiologic effects of inhibition of cyclooxygenase (COX) or for idiosyncratic reasons. Selective COX-1–sparing NSAIDs may be associated with fewer COX-related complications, such as primary gastric injury and bleeding. Adverse effects in other organ systems including liver, skin, and bone may not be diminished with the use of selective COX inhibitors. Prevention of colonic polyps and adenocarcinoma of the colon seems to be mediated by inhibition of the COX-2 isoenzyme.