Propionic acid derivatives are approved for use in the symptomatic treatment of rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, and acute gouty arthritis; they also are used as analgesics, for acute tendinitis and bursitis, and for primary dysmenorrhea.
Ibuprofen, the most commonly used tNSAID in the U.S., was the first member of the propionic acid class of NSAIDs to come into general use, and it is available without a prescription in the U.S. Naproxen, also available without prescription, has a longer but variable t1/2, making twice-daily administration feasible (and perhaps once daily in some individuals). Oxaprozin also has a long t1/2 and may possibly be given once daily.
Small clinical studies suggest that the propionic acid derivatives are comparable in efficacy to aspirin for the control of the signs and symptoms of rheumatoid arthritis and osteoarthritis, perhaps with improved tolerability.
Ibuprofen and naproxen are representative of the class and are described individually below.
PHARMACOLOGICAL PROPERTIES The pharmacodynamic properties of the propionic acid derivatives do not differ significantly. All are nonselective COX inhibitors with the effects and side effects common to other tNSAIDs. Some of the propionic acid derivatives, particularly naproxen, have prominent inhibitory effects on leukocyte function, and some data suggest that naproxen may have slightly better efficacy with regard to analgesia and relief of morning stiffness. Epidemiological studies suggest that while the relative risk of myocardial infarction is unaltered by ibuprofen, it is reduced by around 10% by naproxen, compared to a reduction of 20-25% by aspirin. This suggestion of benefit accords with the clinical pharmacology of naproxen that suggests that some but not all individuals dosed with 500 mg twice daily sustain platelet inhibition throughout the dosing interval.
DRUG INTERACTIONS As do other NSAIDs, the propionic acid derivatives may interfere with the action of antihypertensive and diuretic agents, increase the risk of bleeding with warfarin, and increase the risk of bone marrow suppression with methotrexate. Ibuprofen also has been shown to interfere with the antiplatelet effects of aspirin (see above). There is also evidence for a similar interaction between aspirin and naproxen.
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