The use of H2 antagonists in treating and preventing NSAID-induced mucosal damage

Abstract

Pain affects the quality of life for millions of individuals and is a major reason for healthcare utilization. As populations age, medical personnel will need to manage more and more patients suffering from pain associated with degenerative and inflammatory musculoskeletal disorders. Nonsteroidal anti-inflammatory drugs (NSAIDs) are an effective treatment for both acute and chronic musculoskeletal pain; however, their use is associated with potentially significant gastrointestinal (GI) toxicity. Guidelines suggest various strategies to prevent problems in those at risk for NSAID-associated GI complications. In this article, we review the data supporting one such strategy - the use of histamine type-2 receptor antagonists (H2RAs) - for the prevention of GI adverse events in NSAID users. Older studies suggest that high-dose H2RAs are effective in preventing upper GI ulcers and dyspepsia. This suggestion was recently confirmed during clinical trials with a new ibuprofen/famotidine combination that reduced the risk of ulcers by 50% compared with ibuprofen alone.

Figure 1

Histamine type-2 receptor antagonists and prevention of NSAID-induced upper gastrointestinal toxicity. From [22] (Analysis 8.3). CI, confidence interval; M-H, Mantel-Haenszel.

Figure 2

Incidence for ibuprofen/high-dose famotidine combination versus ibuprofen alone for reduction of NSAID-associated ulcers. From [25] (Figure 2). GI, gastrointestinal; IBU, ibuprofen.

Figure 3

Comparison of ibuprofen/high-dose famotidine combination versus ibuprofen alone for reduction of NSAID-associated ulcers. From [25] (Figure 3). CI, confidence interval; IBU, ibuprofen.