Introduction: The main disadvantage of the nonsteroidal anti-inflammatory drugs (NSAID) is their toxic effect on the gastroduodenal mucosa, which can cause life-threatening complications.
Aims: We discuss the possibilities to prevent the harmful effect of the NSAIDs: the use of safer NSAIDs, and the co-therapy with protective mechanisms.
Methods: Among the safer NSAIDs we discuss the preferentially selective, and the highly selective COX-2 inhibitors, and the new, nitric-oxide releasing NSAIDs. We consider the role of the mucosa-protecting mechanisms: antacids, sucralfate, H2 receptor antagonists, proton-pump inhibitors, and misoprostol.
Conclusions: The most effective opportunities to protect the gastroduodenal mucosa--which is highly recommended for the high risk group of patients--are the usage of highly selective NSAIDs, or the concomitant therapy with proton-pump inhibitors or misoprostol. The value of the letter is diminished by it's side effects.