Nonsteroidal anti-inflammatory drug prescribing: past, present, and future

doi:10.1016/S0002-9343(00)00627-6

The American Journal of Medicine

Volume 110, Issue 1, Supplement 1, 8 January 2001, Pages S4-S7

https://doi.org/10.1016/S0002-9343(00)00627-6 Get rights and content

Abstract

Nonsteroidal anti-inflammatory drugs, including aspirin, are now among the most widely prescribed medications in the world. They have a long and fascinating history, with the use of aspirin derived from willow bark stretching back into the Assyrian culture. In the twenty-first century we are faced with both the challenge of balancing the benefits and side effects of these drugs and the exciting prospect of new, safer agents with comparable efficacy.

Section snippets

Prehistory

Stone tablets from the Sumerian period confirmed that the Assyrians used the extract of willow leaves for painful musculoskeletal conditions and that the Egyptians used a decoction of myrtle and willow leaves for joint pain and for the relief of pain and inflammation associated with wounds. At the height of the Greek empire there was controversy about the most appropriate treatment for pain and inflammation, with Dioscorides favoring the use of coriander and Hippocrates prescribing, in the

St. Kevin of glendalough

One of the most intriguing characters involved in the use of willow bark extract for therapeutic purposes was St. Kevin of Glendalough, who used this medicament to treat painful musculoskeletal conditions in southern Ireland. St. Kevin was a Catholic monk who, awakening one morning in his cell, was so overwhelmed by the beauty of the countryside around him that he stretched his arms out in praise and thanks to God. His right hand extended beyond the bars of his cell and, while he was holding

The eighteenth century

The first quasiscientific description of the use of willow bark as an anti-inflammatory agent is attributed to the Reverend Edmund Stone from Chipping Norton, Oxfordshire, United Kingdom, in 1763. He wrote to the then President of the Royal Society, the Earl of Macclesfield, a letter describing successful treatment of patients with fever, possibly malaria, with about 1 g (20 grains) of powdered willow bark, taken in a “dram” of water every 4 hours. Stone was operating in an almost homeopathic

The nineteenth and early twentieth centuries

In the early nineteenth century, Peruvian willow bark was favored until Napoleon’s blockade of British trade shifted the focus to the use of European willow bark. In 1828, Johann Buchner, professor of pharmacy at Munich, extracted salicin from willow bark. The following year, Henri Leroux obtained crystalline salicin.4 Salicylic acid was first derived from salicin by the Italian chemist Raffaele Piria; its chemical structure was identified in Marburg, Germany, by Hermann Kolbe, who synthesized

Nonaspirin nonsteroidal anti-inflammatory drugs

Compared with aspirin, the nonaspirin NSAIDs (NANSAIDs) have enjoyed a much shorter, although no less fascinating, history. Ibuprofen, the first of the NANSAIDs, was identified from hundreds of candidate compounds by the Boots Company in the early 1950s, and by the 1970s it was being widely prescribed for the treatment of painful musculoskeletal anti-inflammatory conditions. Over the subsequent years, new classes of NANSAIDs were identified and a series of novel agents was brought to market.

Prescribing nonsteroidal anti-inflammatory drugs

In England, in 1998, a total of 513 million prescriptions were written in the National Health Service, at a cost of £4,701 million. Of this number, analgesics comprised 41.5 million prescriptions (8%), accounting for a prescribing cost of £186.8 million (4%). There were about 21 million (4%) prescriptions for drugs for rheumatic diseases and musculoskeletal conditions, accounting for approximately 3.6% of total expenditure.8

The most commonly prescribed NSAID in primary and secondary care in the

Conclusions

NSAIDs are valuable therapeutic agents that are widely prescribed and represent a significant health economic burden, not least because of their problematic side effects. They are nonetheless extremely useful both in a range of nonspecific, often self-limiting, conditions and as longer-term therapy in chronic musculoskeletal problems. Their use has been constrained by their toxicity which, to some extent, can be ameliorated by the use of gastroprotective agents including H₂-receptor

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