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Cardiac glycosidesNSAIDs may exacerbate cardiac failurereduce GFR and increase plasma glycoside levels.
Nervous SystemAnxietyastheniaconfusiondepressiondream abnormalitiesinsomniamalaisenervousnessparesthesiasomnolencetremorsakathisiaconvulsionscomahallucinationsmeningitismood alterations.
Monitor blood pressureBPduring the initiation of NSAID treatment and throughout the course of therapy.
Clinical trials of several COX-2 selective and nonselective NSAIDs of up to three years duration have shown an increased risk of serious cardiovascularCVthrombotic eventsincluding myocardial infarctionMIand strokewhich can be fatalBased on available datait is unclear that the risk for CV thrombotic events is similar for all NSAIDsThe relative increase in serious CV thrombotic events over baseline conferred by NSAID use appears to be similar in those with and without known CV disease or risk factors for CV diseaseHoweverpatients with known CV disease or risk factors had a higher absolute incidence of excess serious CV thrombotic eventsdue to their increased baseline rateSome observational studies found that this increased risk of serious CV thrombotic events began as early as the first weeks of treatmentThe increase in CV thrombotic risk has been observed most consistently at higher doses.
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