Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis

In the past several years, some newer medications have come on the market; these are commonly referred to as COX-2 inhibitors . Remember, all NSAIDs work against cyclooxygenase (COX). Traditional NSAIDs (. Ibuprofen, Motrin, Aleve) work against both COX-1 and COX-2. COX-1 and COX-2 are both types of cyclooxygenase enzymes that function in your body. The new medications (. Celebrex) work primarily against COX-2, and allow COX-1 to function normally. Because COX-1 is more important in producing the protective lining in your gut (gastric mucosa), these newer NSAIDs are believed to have less of a risk of causing stomach ulcers.

During NSAID-anticoagulant concomitant treatment, clinically relevant bleeding occurred with an event rate of per 100 patient-years vs per 100 patient-years during anticoagulant use only (hazard ratio [HR], [95% CI, -]). Major bleeding during NSAID-anticoagulant treatment occurred with an event rate of per 100 patient-years, compared to per 100 patient-years during nonuse (HR, [95% CI, -]). For aspirin-anticoagulant concomitant treatment, clinically relevant bleeding occurred with an event rate of per 100 patient-years, compared to per 100 patient-years during aspirin nonuse (HR, [95% CI, -]). Major bleeding in aspirin-anticoagulant-treated patients occurred with an event rate of per 100 patient-years, compared to per 100 patient-years during aspirin nonuse (HR, [95% CI, -]). Increases in risk for clinically relevant and major bleeding were similar for rivaroxaban and enoxaparin-VKA anticoagulation regimens.

Selective intracellular receptor antagonists are used clinically to ameliorate hormone-dependent disease states. Patients with Cushing's syndrome have high levels of the glucocorticoid, cortisol, and suffer significant consequences from this overexposure. High levels of this hormone are also implicated in exacerbating diabetes and the stress response. Selectively inhibiting this hormone may have clinical benefit in these disease states. To this end, we have identified the first selective, nonsteroidal glucocorticoid receptor (GR) antagonist. This compound is characterized by a tri-aryl methane core chemical structure. This GR-specific antagonist binds with nanomolar affinity to the GR and has no detectable binding affinity for the highly related receptors for mineralocorticoids, androgens, estrogens, and progestins. We demonstrate that this antagonist inhibits glucocorticoid-mediated transcriptional regulation. This compound binds competitively with steroids, likely occupying a similar site within the ligand-binding domain. Once bound, however, the compound fails to induce critical conformational changes in the receptor necessary for agonist activity.

We conducted a multisite retrospective cohort study of commonly used individual NSAIDs in Tennessee Medicaid, Saskatchewan Health, and United Kingdom General Practice Research databases. The cohort included 48566 patients recently hospitalized for myocardial infarction, revascularization, or unstable angina pectoris with more than 111000 person-years of follow-up. Naproxen users had the lowest adjusted rates of serious coronary heart disease (myocardial infarction, coronary heart disease death) and serious cardiovascular disease (myocardial infarction, stroke)/death from any cause, with respective incidence rate ratios (relative to NSAID nonusers) of (95% CI, to ) and ( to ). Risk did not increase with doses >or=1000 mg. Relative to NSAID nonusers, serious coronary heart disease risk increased with short term (<90 days) use for ibuprofen ( [ to ]), diclofenac ( [ to ]), celecoxib ( [ to ]), and rofecoxib ( [ to ]), but not for naproxen ( [ to ]). Relative to naproxen, current users of diclofenac had increased risk of serious coronary heart disease ( [ to ], P=) and serious cardiovascular disease/death ( [ to ], P=), and those of ibuprofen had increased risk of the latter end point ( [ to ], P=). Compared to naproxen in doses >or=1000 mg, serious coronary heart disease incidence rate ratios were increased for rofecoxib >25 mg ( [ to ], P=) and celecoxib >200 mg ( [ to ], P=).

Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis

nonsteroidal anti-inflammatory drugs for pain in women with endometriosis

We conducted a multisite retrospective cohort study of commonly used individual NSAIDs in Tennessee Medicaid, Saskatchewan Health, and United Kingdom General Practice Research databases. The cohort included 48566 patients recently hospitalized for myocardial infarction, revascularization, or unstable angina pectoris with more than 111000 person-years of follow-up. Naproxen users had the lowest adjusted rates of serious coronary heart disease (myocardial infarction, coronary heart disease death) and serious cardiovascular disease (myocardial infarction, stroke)/death from any cause, with respective incidence rate ratios (relative to NSAID nonusers) of (95% CI, to ) and ( to ). Risk did not increase with doses >or=1000 mg. Relative to NSAID nonusers, serious coronary heart disease risk increased with short term (<90 days) use for ibuprofen ( [ to ]), diclofenac ( [ to ]), celecoxib ( [ to ]), and rofecoxib ( [ to ]), but not for naproxen ( [ to ]). Relative to naproxen, current users of diclofenac had increased risk of serious coronary heart disease ( [ to ], P=) and serious cardiovascular disease/death ( [ to ], P=), and those of ibuprofen had increased risk of the latter end point ( [ to ], P=). Compared to naproxen in doses >or=1000 mg, serious coronary heart disease incidence rate ratios were increased for rofecoxib >25 mg ( [ to ], P=) and celecoxib >200 mg ( [ to ], P=).

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