Aspirin and nonsteroidal anti-inflammatory drugs for cancer prevention

AB - Acetylsalicylic acid (ASA) or aspirin and nonsteroidal anti-inflammatory drug (NSAID) sensitivities encompass a diverse group of both pharmacological and hypersensitivity reactions. Conventionally, hypersensitivities include aspirin-exacerbated respiratory disease (AERD), ASA-induced urticaria, and anaphylaxis. With an increasing prevalence of coronary artery disease in an aging population, aspirin continues to play a significant role in cardiac prophylaxis in a large patient population. Invariably, the clinician will encounter patients with clear indications for aspirin therapy but a history of aspirin sensitivity. Although protocols have been established for aspirin challenge and desensitization, it is not always an efficacious or safe procedure. This article reviews the different classifications of ASA/NSAIDs hypersensitivities to better guide the clinician in dealing with this patient population. History of crossrelativities between multiple NSAIDs implies a non-IgE-mediated process. Similarly, a history of monosensitivity to one NSAID implies an IgE-mediated process, although specific antibodies are often elusive. Despite the name, AERD can potentially be exacerbated by all cyclooxygenase (COX) inhibitors based on dose-dependent inhibition of COX-1. Aspirin desensitization can be achieved to improve both upper and lower respiratory symptoms for most patient with AERD. Aspirin desensitization can usually be achieved for those in need of the antiplatelet effects of aspirin, with the exception of those with aspirin-induced urticaria and baseline chronic urticaria. However, desensitization should only be attempted in those with stable coronary artery disease because the process of desensitization carries the inherent risk of anaphylaxis/anaphylactoid reaction, which may further increase cardiac demand and bring about ischemic injury. Therefore, desensitization is reserved until coronary artery disease is stabilized.

COX-2 inhibitors and gastroduodenal toxicity: Major clinical trials
COX-2 selective inhibitors: Adverse cardiovascular effects
Nonselective NSAIDs: Adverse cardiovascular effects
Nonselective NSAIDs: Overview of adverse effects
NSAIDs (including aspirin): Pathogenesis of gastroduodenal toxicity
NSAIDs (including aspirin): Primary prevention of gastroduodenal toxicity
NSAIDs (including aspirin): Role in prevention of colorectal cancer
NSAIDs (including aspirin): Secondary prevention of gastroduodenal toxicity
NSAIDs (including aspirin): Treatment of gastroduodenal toxicity
NSAIDs and acetaminophen: Effects on blood pressure and hypertension
NSAIDs: Acute kidney injury (acute renal failure)
NSAIDs: Adverse effects on the distal small bowel and colon
NSAIDs: Electrolyte complications
NSAIDs: Pharmacology and mechanism of action
NSAIDs: Therapeutic use and variability of response in adults
Overview of selective COX-2 inhibitors

CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.

Aspirin and nonsteroidal anti-inflammatory drugs for cancer prevention

aspirin and nonsteroidal anti-inflammatory drugs for cancer prevention

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