GeriatricNephrologyand Urology 3: 59-60, 1993.
Book Review Side-Effects of Anti-Inflammatory Drugs 3 Edited by K. D. Rainsford and G. P. Velo. Kluwer Academic Publishers, 1992. 375 pp. $149.50. It is difficult to turn a collection of papers presented at a conference into an interesting book. However, editors K. D. Rainsford from McMaster University, Canada, and G. R Velo from the University of Verona, Italy, have done just that. Rainsford and Velo created Side-Effects of AntiInflammatory Drugs 3 from material presented at the Third International Meeting on "Side-Effects of Anti-Inflammatory and Analgesic Drugs." This book is the fifth volume in the inflammation and drug therapy series by the same two editors. While the primary focus of the book is side effects of non-steroidal anti-inflammatory drugs, a section on antirheumatic and immunoregulatory agents is included. This book makes a worthwhile addition to the literature, given the frequent use of antiinflammatory drugs both prescribed and obtained over-the-counter and the problem of their associated adverse reactions. It is of particular interest to rheumatologists and the many clinicians treating patients with arthritis pain. Contributors to this volume include an international group of clinicians and researchers. The 41 papers in the book are divided into seven sections. Non steroidal anti-inflammatory-associated gastrointestinal side effects are among the most frequently reported and most severe adverse drug events. As such, these gastrointestinal complications receive the most discussion in the book. Specifically, one section is devoted to adverse gastrointestinal events: Section II, Gastrointestinal Tract: Clinical Aspects. Another section, Section III, Gastrointestinal Tract: Prevention of Adverse Effects, addresses the role of additional medication to prevent gastroduodenal damage. Given that anti-inflammatory drugs will continue to be widely used, it is appropriate that approaches to improve
side effect recognition and strategies to minimize them be emphasized. Although not as frequently recognized as gastrointestinal toxicity, renal complications are another important problem associated with the use of anti-inflammatory drugs. Accordingly, a section of the book is devoted to discussing the problems of nephrotoxicity: Section V, Nephrotoxicity. Two of the general chapters were particularly interesting. In the chapter "Antirheumatic drug therapy in the elderly" Buchanan and Kean describe the problems of adverse drug reactions in this vulnerable age group. In particular, they highlight that adverse reactions to anti-inflammatory drugs are frequently reported in this older age group, the elderly are often prescribed antiinflammatory drugs for the treatment of arthritis. In addition to the high utilization of anti-inflammatory drugs by older people, altered pharmacokinetic and pharmacodynamic changes associated with aging may also predispose this group to adverse events. This chapter increases the clinicians' awareness of the problems associated with using anti-inflammatory drugs in older people. Another notable chapter in the book is called "What can a spontaneous reporting system teach about side-effects of anti-inflammatory drugs?" In this chapter Ehrlich describes spontaneous reporting systems for adverse drug reactions such as the system organized by the Food and Drug Administration in the United States and the yellow card system used in the United Kingdom. Ehrlich describes how a spontaneous reporting system provides early warning of potential drug problems which may lead to further investigations. While the author notes that there are limitations to the current reporting systems, spontaneous reports have been responsible for identifying problems that have led to all the recent withdrawals of non steroidal anti-inflammatory drugs. My criticisms of this volume are only about the organization and the scope of the material. Section VII, Extended Poster Presentations, could have
60 been omitted and the material from this section allocated to one of the other six sections where the material would have been appropriate. This change would have improved the flow of the book. While anti-inflammatory drugs other than non steroidal anti-inflammatory drugs were discussed at the conference, the vast majority of the book deals only with non steroidal anti-inflammatory drugs. The three chapters in Section VII, Antirheumatic and Immunoregulatory Agents, could have been omitted. There is more than enough information on non steroidal anti-inflammatory drugs to have focused the book exclusively on the toxicity of these drugs.
It is often difficult to find comprehensive and current information on drug toxicity. Overall, this volume provides a good synopsis of information on the toxicity of anti-inflammatory drugs and raises the clinicians' awareness of side effects of these commonly used drugs. Paula A. Rochon, M.D. Baycrest Centre for Geriatric Care 3560 Bathurst Street North York, Ontario Canada M6A 2El
