Non-steroidal anti-inflammatory drugs (NSAIDs) are a group of drugs with anti-inflammatory, analgesic and antipyretic properties. Their wide action and the availability of most of them without a prescription make NSAIDs one of the most commonly used drugs. What is the effect of NSAIDs? What are the indications and contraindications for their use? What's the dosage? What side effects can they cause?

Non-steroidal anti-inflammatory drugs(NSAIDs) are a group of drugs with anti-inflammatory, analgesic and antipyretic properties. Their wide action and the availability of most of them without a prescription make NSAIDs one of the most commonly used drugs. Unfortunately, they are often used inappropriately - e.g. in too high doses, together with other drugs from the NSAID group - which may have dangerous he alth effects.

Non-steroidal anti-inflammatory drugs (NSAIDs) - breakdown

NSAIDs are classified as: ¹

  • salicylic acid derivatives - acetylsalicylic acid (and its esters), choline salicylate, salicylic acid amide, diflunisal
  • phenylacetic acid derivatives - diclofenac, aclofenac, fenklofenac

Currently, the most commonly used NSAIDs are propionic acid derivatives - ibuprofen, naproxen, flurbiprofen, ketoprofen.

  • aliphatic and heterocyclic derivatives - indomethacin, sulindac, tolmetin, acemetacin
  • propionic acid derivatives - ibuprofen, naproxen, flurbiprofen, ketoprofen, thiaprofenic acid
  • anthranilic acid derivatives - flufenamic acid, niflumic acid, mefenamic acid, neclofenamic acid
  • pyrazole derivatives - oxyphenbutazone, phenylbutazone, azapropazone, aminophenazone, noramidopyrine (metamizole)
  • benzothiazine derivatives - piroxicam, meloxicam, sudoxicam, isoxicam
  • naphthylketone derivatives - nabumeton
  • so-called coxib - celecoxib, rofecoxib

Non-steroidal anti-inflammatory drugs (NSAIDs) - action

NSAIDs act by inhibiting the activity of the enzyme cyclooxygenase (COX). There are two types of this enzyme - COX-1 and COX-2. Both are involved in the synthesis of prostaglandins - messengers that they excitepain receptors, and also contribute to the formation of fever and edema. By inhibiting the activity of cyclooxygenase, NSAIDs lead to a reduction in the production of prostaglandins, which results in reduced pain perception, as well as a reduction in swelling and fever. However, COX-1 is additionally involved in the synthesis of prostaglandins, which are responsible for the proper functioning of the digestive system and more. Therefore, inhibition of COX-1 activity reduces the production of prostaglandins that intensify the inflammatory process and, at the same time, also those with a protective effect on the digestive system, which results, among others, in damage to the gastrointestinal mucosa. Hence, some of the side effects after taking NSAIDs.

NSAIDs differ in their potency.

NSAIDs differ in their potency. For example, diclofenac has relatively strong anti-inflammatory and analgesic effects with moderate antipyretic activity. On the other hand, the drugs with moderately strong anti-inflammatory, analgesic and antipyretic properties include aspirin. In turn, the strongest painkiller is metamizole.

Non-steroidal anti-inflammatory drugs have other effects, including inhibit the synthesis of rheumatoid factor (piroxicam), the activity of enzymes that degrade connective tissue (diclofenac, acetylsalicylic acid), the synthesis of free radicals (indomethacin, piroxicam) and prevent the clumping of platelets (acetylsalicylic acid, indomethacin).

Recent research has shown that NSAIDs may also prevent colon cancer and are protective in Alzheimer's disease.

Non-steroidal anti-inflammatory drugs (NSAIDs) - indications

Pain of various origins, mild to moderate, including:

  • headaches (including migraines)
  • toothache
  • muscle pains
  • pain in the lumbosacral region
  • bone and joint pains
  • dysmenorrhea

Other indications for the use of NSAIDs include fever (including influenza, colds or other infectious diseases) and rheumatic diseases (e.g. rheumatoid arthritis, osteoporosis). In addition, NSAIDs are used temporarily in myocardial infarction and unstable angina, as well as in the prevention of blood clots and strokes.

Non-steroidal anti-inflammatory drugs (NSAIDs) - contraindications

  • age - under 12
  • digestive system diseases (especially gastric ulcer and / or duodenal ulcer disease) and chronic inflammatory bowel diseases (ulcerative colitis, Crohn's disease).
  • hypertension i(or) disturbance of the heart rhythm

Do not combine several NSAIDs simultaneously.

  • blood coagulation disorders
  • severe liver, kidney or heart failure
  • renal and hepatic dysfunction
  • Taking other non-steroidal anti-inflammatory drugs at the same time, including COX-2 inhibitors
  • hemorrhagic diathesis
  • pregnancy (especially its third trimester) and breastfeeding period
  • lupus erythematosus and mixed connective tissue disease
  • symptoms of allergic reactions after taking acetylsalicylic acid
  • taking other medications (especially anticoagulants, diuretics, cardiac drugs, corticosteroids)

Non-steroidal anti-inflammatory drugs (NSAIDs) - side effects

Gastrointestinal disorders such as nausea, vomiting, diarrhea or constipation, gastric irritation, gastric ulcer, anemia (resulting from chronic bleeding), gastrointestinal bleeding, ulceration may occur after taking NSAIDs. intestine, malabsorption.

May also develop interstitial nephritis, decreased glomerular filtration, and tubular dysfunction.

NSAIDs aggravate the symptoms of heart failure in the elderly. They may also increase high blood pressure.

NSAIDs can also cause nervous system disorders, such as: headaches, disturbed consciousness, depressed mood, muscle tremors, aseptic meningitis, dizziness, neuropathy, tinnitus, personality disorders.

Taking some NSAIDs may be associated with a slightly increased risk of a heart attack or stroke. The risk is increased by the long-term intake of high doses of the drug. Therefore, higher doses and longer duration of treatment than recommended should not be used.

Rare side effects of NSAID use include: vasculitis, pericarditis and myocarditis, aplastic anemia, decreased platelet count, haemolytic anemia, aseptic meningitis, and membranous enterocolitis. Toxic liver damage is also rare.

Severe skin reactions, some of them fatal, exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis, are very rare.

In people with active or previous bronchial asthma or allergic diseases, the use of NSAIDs may cause bronchospasm.

NSAIDs may be detrimentalon female fertility. However, this effect wears off after you stop taking your medications.

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Non-steroidal anti-inflammatory drugs - dosage¹

The dosage of NSAIDs depends on the type of drug. For example, the maximum dose of diclofenac is 200 mg / day, and the maximum dose of ketoprofen is 300 mg / day. In turn, naproxen is already 1000 mg / d. The daily dose of the popular ibuprofen is slightly higher - 1200-3200 mg / day. In turn, salicylic acid can be taken in a dose of 2500-6000 mg / day.

NSAID - symptoms of overdose

After taking more than the recommended dose, symptoms such as nausea, vomiting, epigastric pain or, less frequently, diarrhea may appear. Tinnitus, headache and gastrointestinal bleeding may also occur. Severe poisoning affects the central nervous system and manifests itself with insomnia, and very rarely with agitation, disorientation or coma. Convulsions may occur very rarely. Overdosing may lead to liver and kidney failure.

Sources:

1. Puszczewicz M.,Non-steroidal anti-inflammatory drugs,"Doctor's Guide" 2007, No. 3

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