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Indications:

Bumadizone calcium is an NSAID Its use was limited by the risk of agranulocytosis and other haematological adverse effects. Inflammation; peri-articular and soft-tissue disorders

Contraindications:

contra-indicated in patients with a history of hypersensitivity reactions to such drugs, including those in whom attacks of asthma, angioedema, urticaria, or rhinitis have been precipitated by aspirin or any other NSAID contra-indicated in patients with active peptic ulceration

Adverse reactions:

The commonest adverse effects of NSAIDs are generally gastrointestinal disturbances, such as gastrointestinal discomfort, nausea, and diarrhoea; these are usually mild and reversible but in some patients peptic ulceration and severe gastrointestinal bleeding may occur. It is generally agreed that inhibition of cyclo-oxygenase-1 (COX-1) plays an important role in the gastrointestinal effects of NSAIDs; the selective inhibition of COX-2 improves gastrointestinal tolerance. CNS-related adverse effects include headache, vertigo, dizziness, nervousness, tinnitus, depression, drowsiness, and insomnia. Hypersensitivity reactions may occur occasionally and include fever, angioedema, bronchospasm, and rashes. Hepatotoxicity and aseptic meningitis, which occur rarely, may also be hypersensitivity reactions. Some patients may experience visual disturbances. Haematological adverse effects of NSAIDs include anaemias, thrombocytopenia, neutropenia, eosinophilia, and agranulocytosis. Unlike aspirin, inhibition of platelet aggregation is reversible with other NSAIDs. Some NSAIDs have been associated with nephrotoxicity such as interstitial nephritis and nephrotic syndrome; renal failure may be provoked by NSAIDs especially in patients with pre-existing renal impairment. Haematuria has also occurred. Fluid retention may occur, rarely precipitating heart failure in elderly patients. Long-term use or abuse of analgesics, including NSAIDs, has been associated with nephropathy. Other adverse effects include photosensitivity. Alveolitis, pulmonary eosinophilia, pancreatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare adverse effects. Induction or exacerbation of colitis has also been reported.

Interactions:

Interactions involving NSAIDs include enhancement of the effects of oral anticoagulants (especially by azapropazone and phenylbutazone) and increased plasma concentrations of lithium, methotrexate, and cardiac glycosides. The risk of nephrotoxicity may be increased if given with ACE inhibitors, ciclosporin, tacrolimus, or diuretics. Effects on renal function may lead to reduced excretion of some drugs. There may also be an increased risk of hyperkalaemia with ACE inhibitors and potassium-sparing diuretics. The antihypertensive effects of some antihypertensives including ACE inhibitors, beta blockers, and diuretics may be reduced. Convulsions may occur due to an interaction with quinolones. NSAIDs may enhance the effects of phenytoin and sulfonylurea antidiabetics. Use of more than one NSAID together (including aspirin) should be avoided because of the increased risk of adverse effects. The risk of gastrointestinal bleeding and ulceration associated with NSAIDs is increased when used with corticosteroids, the SSRIs, the antiplatelets clopidogrel and ticlopidine, or, possibly, alcohol, bisphosphonates, or pentoxifylline. There may be an increased risk of haematotoxicity if zidovudine is used with NSAIDs. Ritonavir may increase the plasma concentrations of NSAIDs. Licensed product information for mifepristone advises of a theoretical risk that prostaglandin synthetase inhibition by NSAIDs or aspirin may alter the efficacy of mifepristone. There have been occasional reports of increased adverse effects when NSAIDs were given with misoprostol although such combinations have sometimes been used to decrease the gastrointestinal toxicity of NSAIDs.

Warnings:

NSAIDs should be used with caution in patients with infections, since symptoms such as fever and inflammation may be masked (for the suggestion that they should not be used in children with varicella They should also be used with caution in patients with asthma or allergic disorders.

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