Nonsteroidal Anti-Inflammatory Poisoning

Nonsteroidal Anti-Inflammatory Poisoning is a topic covered in the 5-Minute Emergency Consult.

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  • Inhibit cyclooxygenase (COX), thereby blocking the conversion of arachidonic acid to prostaglandin.
  • Typically morbidity is low when an NSAID is ingested
  • Most literature on nonselective NSAID toxicity involves ibuprofen exposure likely due to its OTC availability.
  • Fatalities have been reported with large ingestions.
  • Greater potential for toxicity with underlying CHF or renal failure:
    • NSAIDs cause sodium and water retention and decrease renal blood flow.
    • Little overdose experience with the COX-2 inhibitors (celecoxib); treatment should be the same as for the traditional NSAIDs.
    • Patients may ingest rofecoxib and valdecoxib from stored supplies even though both are no longer available in US


  • Nonsteroidal medications are available by prescription and over-the-counter.
  • NSAIDs include:
    • Diclofenac
    • Diflunisal
    • Etodolac
    • Fenoprofen
    • Ibuprofen
    • Indomethacin
    • Ketoprofen
    • Ketorolac
    • Meclofenamate
    • Meloxicam
    • Nabumetone
    • Naproxen
    • Oxaprozin
    • Piroxicam
    • Sulindac
    • Tolmetin

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