What is an adverse effect of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): hypotension, uterine contraction, thrombus formation, or vasomotor rhinitis?

From the Guidelines

Thrombus formation is a significant adverse effect of NSAIDs, as they can increase the risk of cardiovascular events by inhibiting prostaglandin synthesis and affecting platelet function. NSAIDs can cause an increased risk of thrombus formation due to their antiplatelet effects, which can be particularly problematic in patients with preexisting cardiovascular disease or those taking anticoagulants 1. The combination of NSAIDs with anticoagulants can significantly increase the risk of gastrointestinal bleeding, highlighting the need for careful consideration and monitoring in patients requiring both types of medications 1.

Some key points to consider when evaluating the adverse effects of NSAIDs include:

• The risk of thrombus formation and cardiovascular events associated with NSAID use, particularly in patients with preexisting cardiovascular disease 1
• The potential for NSAIDs to interact with anticoagulants and increase the risk of gastrointestinal bleeding 1
• The importance of careful patient selection and monitoring when prescribing NSAIDs, particularly in patients with compromised cardiovascular systems or those taking other medications that affect blood pressure 1
• The need for patients taking NSAIDs to be aware of the potential signs of thrombus formation, such as chest pain or shortness of breath, and to seek medical attention immediately if they experience any of these symptoms.

In terms of the other options, hypotension is also a potential adverse effect of NSAIDs, as they can cause vasodilation and decreased blood pressure in some patients 1. Uterine contraction is not a commonly reported adverse effect of NSAIDs, and vasomotor rhinitis is not typically associated with NSAID use. However, the most significant concern with NSAID use is the increased risk of thrombus formation and cardiovascular events, particularly in patients with preexisting cardiovascular disease.

From the FDA Drug Label

NSAIDs can cause serious side effects, including: Increased risk of a heart attack or stroke that can lead to death Increased risk of bleeding, ulcers, and tears (perforation) of the esophagus (tube leading from the mouth to the stomach), stomach and intestines Other side effects of NSAIDs include: stomach pain, constipation, diarrhea, gas, heartburn, nausea, vomiting and dizziness In patients taking NSAIDs, the following adverse experiences have also been reported in approximately 1% to 10% of patients Gastrointestinal (GI) Experiences: including: flatulence, gross bleeding/perforation, GI ulcers (gastric/duodenal), vomiting General: abnormal renal function, anemia, elevated liver enzymes, increased bleeding time, rashes The following are additional adverse experiences reported in < 1% of patients taking naproxen during clinical trials and through postmarketing reports Body as a Whole: anaphylactoid reactions, angioneurotic edema, menstrual disorders, pyrexia (chills and fever) Cardiovascular: congestive heart failure, vasculitis, hypertension, pulmonary edema Gastrointestinal: inflammation, bleeding (sometimes fatal, particularly in the elderly), ulceration, perforation and obstruction of the upper or lower gastrointestinal tract Esophagitis, stomatitis, hematemesis, pancreatitis, vomiting, colitis, exacerbation of inflammatory bowel disease (ulcerative colitis, Crohn's disease) In patients taking NSAIDs, the following adverse experiences have also been reported in < 1% of patients fection, sepsis, anaphylactic reactions, appetite changes, death Cardiovascular: hypertension, tachycardia, syncope, arrhythmia, hypotension, myocardial infarction

The adverse effects of NSAIDs include thrombus formation (increased risk of a heart attack or stroke), hypotension (reported in < 1% of patients).

• Uterine contraction and vasomotor rhinitis are not mentioned in the provided drug labels as adverse effects of NSAIDs.

From the Research

Adverse Effects of NSAIDs

The potential adverse effects of NSAIDs include:

• Gastrointestinal ulcers
• Serious cardiovascular events
• Hypertension
• Acute renal failure
• Worsening of preexisting heart failure 2
• Thrombus formation, as NSAIDs affect platelet aggregation and vascular tone 3, 4

Specific Adverse Effects

In terms of the options provided:

• Hypotension is not typically listed as an adverse effect of NSAIDs
• Uterine contraction is not directly mentioned in the provided studies
• Thrombus formation is a potential adverse effect, as NSAIDs can affect platelet aggregation and vascular tone 3, 4
• Vasomotor rhinitis is not mentioned in the provided studies as an adverse effect of NSAIDs

Prevention of Adverse Effects

To prevent adverse effects, it is recommended to:

• Limit NSAID dosage and duration
• Perform individual risk assessments and treat patients accordingly
• Use concomitant proton-pump inhibitors, misoprostol, and/or COX-2 selective NSAIDs for those at risk of gastroduodenal ulcers
• Avoid NSAID use altogether for those at risk of cardiovascular events 2