pasti praktisi yang menganjurkan penggunaan ibuprofen di antara NSAID lainnya sudah mempertimbangkan risk and benefit, termasuk efek sampingnya terhadap mukosa saluran cerna. kalo semua melihat ke risk aja ga ada obat demam yang aman untuk anak.

m.., berarti selama :
1. Orang itu tidak ada gangguan lambung
2. Dosisnya dalam batas wajar

maka tidak masalah menggunakan Ibuprofen
bgitu ya Om?

Oia Om, mau tanya juga, Kalau misalnya ada pasien, dia kena gangguan Liver + Ginjal yang berarti. Na kan itu berarti kita harus hati2 menggunakan obat2an kan, terutama yang ada kontra indikasi penderita gangguan hati dan ginjal. Untuk obat2an, kan banyak yang KI terhadap itu. Jika kita menemui pasien ini, apa sebaiknya yang kita lakukan jika memang dia benar2 butuh obat  (misal, kena Gout dan harus dikasi Sulfynpyrazone, atau perlu Kortiko, padahal Kortiko ada efek retensi Na nya)?

All Nonsteroidal Anti-Inflammatory Drugs Have Cardiovascular Risks

January 21, 2011 — New data showing nonsteroidal anti-inflammatory drugs (NSAIDs) have cardiovascular risks are putting the well-known pain relievers back in the headlines. Investigators evaluating available evidence report they have found little to suggest that any of the investigated options are safe.

Regulatory agencies have already pointed to cardiovascular signals with NSAIDs, but these concerns are based mainly on observational evidence. This new study provides a comprehensive analysis of all randomized controlled trials of the drugs.

During an interview with Medscape Medical News, senior investigator Peter Jüni, MD, from the University of Bern in Switzerland, said his team expected to see an increased risk but was surprised by the magnitude of the signal. "We never thought we'd see 2- and 4-fold increased risks," he said. "The doses were admittedly high," he pointed out, "however, this is clearly clinically relevant."

Several earlier meta-analyses were unable to resolve the debate over risk because they failed to include all randomized evidence in 1 study. This new network meta-analysis, published online January 11 in BMJ, includes all available evidence.

The team led by Sven Trelle, MD, also at the University of Bern, included 31 trials and 116,429 patients taking naproxen, ibuprofen, diclofenac, celecoxib, etoricoxib, lumiracoxib, rofecoxib, or placebo.

Investigators saw an increase in myocardial infarctions, stroke, and cardiovascular death in patients taking all of these NSAIDs. Not surprisingly, rofecoxib was associated with the highest risk for myocardial infarction, with a rate ratio of 2.12. The drug's manufacturer, Merck, voluntarily withdrew the product marketed as Vioxx  in 2004 because of concerns over cardiotoxicity.

Lumiracoxib had the next highest rate of myocardial infarction in the current study. Ibuprofen was associated with the highest risk for stroke with a rate ratio of 3.36 followed by diclofenac at 2.86. Etoricoxib was linked to the highest rate of cardiovascular death at 4.07 followed by diclofenac at 3.98.

Dr. Jüni recommends that physicians take special care in evaluating patients prone to cardiovascular events. Those who require treatment should take the lowest possible dose for the shortest period.

Dr. Jüni says he would like to see black box warnings added to drug packaging for the products still available on the market.

Of all the NSAIDs, naproxen seemed least harmful in this study. The finding is in agreement with recommendations made by regulatory agencies when rofecoxib was first removed from the market and physicians were evaluating alternatives.

"I think we should reserve our final judgment on naproxen until after we've completed the overall safety study," Dr. Jüni said. His team is currently studying the gastrointestinal safety of the drug and weighing the benefits and risks from that perspective.

"With naproxen, we tend to need a proton pump inhibitor to protect the stomach," Dr. Jüni added. "This is far from ideal."

No Clear Link Between Specificity and Risk

In an interesting twist, investigators found no clear relation between specificity of cyclooxygenase-2 inhibitors and risk for cardiovascular events. This finding contrasts with previous claims that increased selectivity for cyclooxygenase-2 inhibitors is associated with cardiovascular risk.

Several mechanisms have been proposed, but the hypothesis of an imbalance between prostacyclin and thromboxane A2 leading to an increased risk for thrombotic events is the most well known.

The researchers suggest the lack of a clear association between specificity of cyclooxygenase-2 inhibitors and cardiovascular risk implies that other mechanisms should be considered. "Multiple effects most probably contribute to the increased risk of cardiovascular events, including differential effects on prostacyclin and thromboxane A2 synthesis, endothelial function, nitric oxide production, blood pressure, volume retention, and other renal effects," they note.

Millions of Patients Taking NSAIDs

In an accompanying editorial, Wayne Ray, PhD, from Vanderbilt in Nashville, Tennessee, pointed out that millions of patients with chronic musculoskeletal symptoms are long-term NSAID users.

In the United States, an estimated 5% of all visits to a physician are related to prescriptions of anti-inflammatories, and they are among the most commonly used medications.

"Given that both mechanistic and clinical data suggest that individual NSAIDs may have different cardiovascular risk profiles," Dr. Ray noted, "a natural question is, 'Which NSAID is safest for patients with high cardiovascular risk?'"

He points out the ongoing PRECISION trial, otherwise known as the Prospective Randomized Evaluation of Celecoxib Integrated Safety versus Ibuprofen Or Naproxen, will eventually provide more information on the relative cardiovascular safety of these options. "Until these results become available, naproxen seems to be the best choice with regard to cardiovascular safety."

Dr. Ray says the controversy and confusion about the cardiovascular safety of these products provides an important lesson. "Drugs for symptomatic relief must be evaluated with regard to the target symptoms as well as less frequent yet serious adverse effects. NSAIDs are not an ideal treatment with respect to efficacy or safety. Perhaps it is time for a larger more systematic evaluation of a broader range of alternatives."

This study was funded by the Swiss National Science Foundation. The researchers have disclosed no relevant financial relationships. Editorialist Dr. Wayne Ray has received funding from Pfizer. He served as an expert for the State of Texas in a lawsuit filed against Merck. Dr. Ray also works as an expert for an insurance company.

BMJ. 2011;342:c7086.

yg pasti musti selektif dalam pemilihan obatnya. pertama mencari obat alternatif yang aman untuk kondisi tertentu, misalnya allopurinol untuk gout. kedua mempertimbangkan risk-and-benefit dari obat yang akan digunakan, apakah obat akan meringankan gejala ato malah memperberat penyakit dalam tubuh.

M.., gtu y, ok mksi banyak Om..,

"With naproxen, we tend to need a proton pump inhibitor to protect the stomach," Dr. Jüni added. "This is far from ideal."

Hm, bukannya Proton Pump Inhibitor itu mahal y Om, klo alternatif untuk inin apa ya Om?

mau nanya , apakah setiap molekul prostaglandin akan menempati reseptornya sendiri? seperti PGF-alfa dsbg...kalau iya, bisa ga ya kita ciptakan obat yang khusus menghalangi menempelnya PG pemicu nyeri ini ke reseptornya? biar lebih selektif dan efek samping lebih sedikit

menarik2, gimana om syx?

@idad
Proton pump inhibitor kayaknya ngga mahal2 amat deh, udah banyak yg generik: omeprazole, lansoprazole

oya, wh, sepertinya sy harus update info lagi..,,
ok2, mksi bang rian..,

September 6, 2011 — Use of nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) in early pregnancy is linked to twice the risk for miscarriage, according to the results of a nested case-control study reported online September 6 in the Canadian Medical Association Journal.

hati-hati penggunaan NSAID selain aspirin saat hamil muda...