A review of the medical literature has found that the risk of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) associated with the use of nonsteroidal antiinflammatory drugs (NSAIDs) is extremely low. The greatest risk can be seen in older patients, women, and patients within the first month of treatment initiation.

The authors of this review searched for studies, case series and case reports of SJS and TEN associated with NSAIDs and cyclooxygenase-2-selective NSAIDs available in the United States. From the available data they made the following observations (data from abstract as full report not available):

• “oxicam” derivatives appeared to have the greatest association with SJS and TEN. The relative risks reported with other NSAIDs are much lower.
• The risk with cyclooxygenase-2-selective NSAIDs and meloxicam is less clear, since all were introduced after the completion of the epidemiological studies.
• SJS or TEN from NSAIDs and cyclooxygenase-2-selective NSAIDs appears to affect the same patient population as other medications that cause SJS or TEN.
• The risk of SJS or TEN caused by NSAIDs is extremely low (less than 2 per 1 million users per week for oxicam derivatives, less than 1 per 1 million users per week for other NSAIDs, and 6 cases per 1 million person-years for celecoxib).
• Aspirin is not typically associated with SJS or TEN. Of the other salicylates, SJS or TEN has only been reported with diflunisal.