La lettre de l'institut Upsa de la douleur - 9

AINS et inhibiteurs sélectifs de la COXrofecoxib sont, par contre, une innovationen matière de développementdu médicament et offrent enfin la perspectived’une meilleure tolérance etsécurité digestive au prix d’une efficacitéconservée dans le traitementsymptomatique des affections chroniquescomme l’arthrite rhumatoïde oul’arthrose invalidante. Leur caractéristiquespharmacocinétiques et le tempsn é c e s s a i re à l’obtention de l’état d’équili b re de quelques jours limitent en eff e tleur attrait dans la prise en charge dedouleurs aiguës ou subaiguës. Les nouvellesgénérations à courte demi-viedevraient combler cette lacune dans ledomaine de la douleur aiguë par excèsde nociception.L’innocuité digestive apparente desinhibiteurs COX-2 sélectifs suggère n tune utilisation accrue dans les annéesa v e n i r. Leur sélectivité demeurecependant relative et des surd o s a g e s● Amin A.R., Attur M., Abramson S.B., Nitric oxidesynthase and cyclooxygenases : distribution, regulation,and intervention in arthritis. Curr Opin Rheumatol 11;2 0 2 - 9: 1999● Banwarth B., Demotes-Mainard F., Schauberle T. ,Labat L., Dehais J. Central analgesic effets of aspirinlike drugs. Fundam Clin Pharmacol. 9,1-7,1995● Barner A. Review of clinical trials and benefit/riskratio of meloxicam. Scand J Rheumatol Suppl 102;2 9 - 3 7 : 1996● Bateman DN. NSAID’s : Time to re-evaluate gutt o x i c i t y. Lancet 343; 1051-1052 : 1994● Battistini B., Botting R., Bakhle YS. Cox-1 andC o x - 2 : Toward the developpment of more selectiveN S A I D ’s. Drug News and perspective 7; 501-512 :1 9 9 4 .● Besson J.M., The neurobiology of pain. Lancet 353 ;1 6 1 0 - 1 6 1 5: 1999● Besson, J. M. et Chaouch, A.. Peripheral and spinalmechanisms of nociception. 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