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Nonsteroidal Anti-Inflammatory Drug Poisoning, Sports Medicine

Kenneth P. Barnes, MD, MSc, CAQSM, FACSM and Shane Hudnall, MD, CAQSM Reviewed 04/2019


  • Primary effect is competitive inhibition of cyclooxygenase (COX) enzyme, thus inhibiting production of prostaglandins, thromboxanes, and prostacyclin from arachidonic acid.

  • There are two COX iso...



  • Although significant symptoms may occur after 5 to 10 times the maximum dose has been ingested, there is a poor correlation between the amount ingested and toxic poisoning.

  • Timing of i...


  • Acute treatment:

    • Supportive measures:

      • Call poison control.

      • Secure the ABCs.

      • There is no antidote for NSAID poisoning.

      • Close monitoring is warranted for almost all patients, and usually, this is t...


Silverstein FE, Faich G, Goldstein JL, et al. Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study:...


  • Hunter LJ, Wood DM, Dargan PI. The patterns of toxicity and management of acute nonsteroidal anti-inflammatory drug (NSAID) overdose. Open Access Emerg Med.  2011;3:39–48.

  • Peraz...


  • There is no additional benefit to giving >1 dose of activated charcoal.

  • Ipecac has fallen out of favor for most acute ingestions and is not recommended for NSAID toxicity.

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