Although NSAIDs may be required to alleviate rheumatic complications due to systemic lupus erythematosus (SLE), extreme caution in its use is recommended, since patients with SLE may be predisposed to NSAID toxicity in the central nervous system and / or renal.
Adverse reactions can be minimized by administering the lowest effective dose and the shortest time required to control symptoms.
Caution should be exercised in patients taking concomitant NSAIDs and medicinal products that may increase the risk of bleeding or ulcer, such as oral corticosteroids, anticoagulants such as warfarin, selective serotonin reuptake inhibitors, antiplatelet agents such as acetylsalicylic acid or nicorandil.
Gastrointestinal bleeding, ulcer and perforation, which may be fatal, have been reported with all NSAIDs during any period of treatment, with or without symptoms or history of severe gastrointestinal events.
Clinical studies and epidemiological data suggest that the use of NSAIDs (except aspirin), particularly at high doses and in long-term treatments, may be associated with an increased risk of arterial thrombotic events (eg, myocardial infarction or stroke ) .
As with other non-steroidal anti-inflammatory drugs (NSAIDs), caution should be exercised in the use of uncontrolled hypertensive patients, congestive heart failure, established ischemic heart disease, peripheral arterial disease and / or cerebrovascular disease, and before initiating long-term treatment in patients with risk factors for cardiovascular disease (eg hypertension, hyperlipidemia, diabetes mellitus, and in smokers).
An increased risk of arterial thrombotic events has been reported in patients treated with non-AAS NSAIDs for perioperative pain resulting from myocardial revascularization surgery (CABG).
Severe skin reactions, some fatal, including exfoliative dermatitis , Stevens-Johnson syndrome, and toxic epidermal necrolysis have been reported very rarely with NSAIDs. There is a greater risk of the occurrence of these adverse reactions at the beginning of treatment, the majority of cases occurring in the first month.
As with other NSAIDs, in the presence of infectious disease, it should be noted that the anti-inflammatory, analgesic and anti-thermal properties of NSAIDs may mask the usual signs of infection progression, such as fever .
In patients with abnormal hepatic function tests or with a history of liver disease, transaminase levels should be evaluated periodically, particularly during long-term treatment. Rare cases of jaundice and hepatitis have been reported with the use of ketoprofen.
If visual disturbances such as blurred vision occur, treatment with NSAIDs should be discontinued.