Toxicity of the nonsteroidal anti-inflammatory drugs.

The nonsteroidal anti-inflammatory drugs continue to be prescribed frequently around the world to palliate the pain and inflammation associated with various medical conditions. These are a heterogenous group of drugs with similar mechanisms of action, yet they are very different chemically and at times possess different potential risks for toxicity. The risk factors for renal dysfunction after therapy with various nonsteroidal anti-inflammatory drugs are reviewed. In addition glomerulopathy and tubular dysfunction are discussed. Further information about nonsteroidal anti-inflammatory drug-induced gastroduodenal erosive disease and who is at risk is presented. Potential methods for preventing mucosal ulcers or treating them once established are discussed. Other recently described nonsteroidal inflammatory drug-induced toxicities, including hepatotoxicity, esophagitis, and the formation of small and large bowel mucosal diaphragms precipitating obstruction are reviewed.