LETTER
Misoprostol and Nonsteroidal Anti-Inflammatory Drugs
Julie Ruzzo Moore, RPh, MBA
1 June 1996 | Volume 124 Issue 11 | Page 1015
TO THE EDITOR:
We read with interest Dr. Levine's recent editorial, in which he stated, "... I would prescribe low doses of NSAIDs such as ibuprofen and nabumetone, which induce less gastropathy" [1].
A randomized, endoscopist-blinded, 12-week study compared the relative effects of nabumetone, ibuprofen, and ibuprofen plus misoprostol on the mucosa of the esophagus, stomach, and duodenum in elderly patients treated for osteoarthritis [2]. Patients were randomly assigned to receive ibuprofen, 600 mg four times daily (n = 53); ibuprofen, 600 mg four times daily, plus misoprostol, 200 µg four times daily (n = 58); or nabumetone, 1000 mg daily (n = 58). One significant ulcer (> 5 mm in size with measurable depth) occurred with nabumetone, and no significant ulcers occurred with ibuprofen plus misoprostol. However, eight significant ulcers occurred in the group receiving ibuprofen alone. Roth and colleagues [2] concluded that nabumetone has an ulcerogenic potential equal to that of ibuprofen plus misoprostol but is significantly less ulcerogenic than ibuprofen alone.
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Author and Article Information
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SmithKline Beecham; Philadelphia, PA 19101
1. Levine JS. Misoprostol and nonsteroidal anti-inflammatory drugs: a tale of effects, outcomes and costs [Editorial]. Ann Intern Med. 1995; 123:309-10.
2. Roth SH, Tindall EA, Jain AK, McMahon FG, April PA, Bockow BI, et al. A controlled study comparing the effects of nabumetone, ibuprofen, and ibuprofen plus misoprostol on the upper gastrointestinal tract mucosa. Arch Intern Med. 1993; 153:2565-71.
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