Presse Med
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When prescribing a non-steroidal anti-inflammatory treatment but also an analgesic or a glucocorticoid, the cardiovascular risk of the patient should be assessed. The analgesics have few cardiovascular side effects and the main complications observed are linked essentially to the vagal action of the opioids. ⋯ An overdose of dextropropoxyphene can result in cardiotoxicity. On the other hand, the glucocorticoids need to be prescribed cautiously, at the lowest possible dose and for the shortest possible duration due to the non-negligible cardiovascular risk, hypertension, dyslipidemia, hypokaliemia.
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Review Comparative Study
[Are there any differences in the cardiovascular tolerance between classical NSAIDs and coxibs?].
Three placebo-controlled studies have demonstrated deleterious cardiovascular (CV) effects of rofecoxib, celecoxib, and pare/valdecoxib. It remains to be determined whether this CV toxicity is specific to coxibs, or shared with all non-steroidal anti-inflammatory drugs (NSAIDs). Seven meta-analyses show that, in comparison with non-specific NSAIDs, the risk of thrombotic CV accident is increased with rofecoxib and celecoxib, but not with valdecoxib or lumiracoxib. ⋯ These studies suggest that all the NSAIDs, specific or not, increase the CV and renal risk. This risk seems variable from a compound to another one and must be evaluated, for each patient, according to the susceptibility and associated risk factors. While waiting for other long-term controlled studies, the available data show the existence of a risk of CV secondary effect linked to the class of NSAIDs, specific (coxibs) or not.
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Selective serotonin reuptake inhibitors (SSRIs) have been used increasingly since the early 1990s to treat anxiety disorders and depression in children and adolescents. Several recent reports, however, cast doubt on their efficacy and especially raise questions about their role in serious adverse effects (increase in suicidal ideation and suicide attempts as well as reactions involving irritability, hostility, self-harm and self-destructive actions). The efficacy of SSRIs (fluoxetine, sertraline, fluvoxamine, paroxetine) in the treatment of obsessive-compulsive disorders in this population is clear today, although their effects are globally relatively modest. ⋯ Moreover, because of the risk of suicidal behavior observed in some studies, SSRIs are inadvisable for the treatment of depressive disorders in this population. Overall, although the currently available data show SSRIs to be moderately effective and useful in treating anxiety disorders and depression in children and adolescents, future studies must focus on more precise identification of their indications, especially relative to psychotherapeutic strategies, which are still considered to be the first-line treatment in these disorders. From a legal point of view, only sertraline has been authorized in France for the treatment of obsessive-compulsive disorders in this population.