by Dr. Manura Nanayakkara

Created on: June 07, 2010   Last Updated: July 10, 2010

NSAID is Abbreviated word for Non-Steroidal Anti Inflammatory Drugs. They are commonly used medications. They are used for pain, fever, and higher doses for inflammation. The term non-steroidal is used to differentiate this class of medications from steroidal drugs, which has similar mechanism of action.

NSAIDS acts by inhibiting an enzyme called Cyclo – Oxygenase (COX).  Older NSAIDS block both COX1 and COX2. Newer NSAIDS like Celecoxib inhibit mainly COX2.  COX1 inhibition causes most of the gastric side effects.

Most common over the counter NSAIDs are Aspirin (Caprin ®), Ibuprofen (Brufen ®), and Naproxen (Naprosyn ®). Prescription only NSAIDS are Diclofenac (Voltarol ®), Indomethacin (Indocin®), Meloxicam (Mobic®), Mefenamic acid (Ponstan ®), and Celecoxib (Celebrex ®). Celecoxib is a selective COX 2 Inhibitor. Several other selective COX2 inhibitors are withdrawn from the market due to cardiac side effects E.g. Rofecoxib, and Valdecoxib.

Mechanism of pain and inflammation includes involvement of hormonal like substance called Prostaglandins. Mechanism of fever also involves Prostaglandins, especially inside Hypothalamus.

Inhibition of Cyclo Oxygenases causes decreased levels of pain producing Prostaglandins as well as fever producing Prostaglandins (Prostaglandin E2). This results in reduction of pain and inflammation. These medications are more effective in treating fever than Acetaminophen as well.

Unlike acetaminophen NSAIDS decrease blood clot formation by platelets, which can lead to bleeding.  For this reason it should not be taken by patients with existing bleeding disorders. It is dangerous to give NSAIDS to viral fevers persisting more than three days as well. Some viral fevers can reduce platelet number.

Prostaglandins are used by the body as hormonal agents in protecting stomach from its own acidic juice. Since NSAIDS reduce prostaglandins, they cause gastric irritation and gastric/duodenal (part situated distally to stomach) ulcers.

Long term regular use of NSAIDS is known to be associated with Irreversible Kidney Damage as well.

Most common uses are Rheumatoid arthritis, Osteoarthritis, Inflammatory Joint disorders (e.g. ankylosing spondylitis, psoriatic arthritis, Reiter's syndrome), acute gout, Dysmenorrhea (menstrual pain), Bone pain in widespread cancer, Headache and migraine, Pain following surgery, Mild-to-moderate pain due to tissue injury, Dental pain, Fever, and Kidney Stones.

You should not use over the counter NSAIDS, if you have kidney diseases, Liver diseases, NSAIDs Allergy and Bleeding disorders. If you have a history of stomach ulceration and gut bleeding, then you should avoid these medications. You should not take NSAIDs, if you are either pregnant or nursing.

If your doctor plans to give you NSAIDs, Then doctor should know whether you have above-mentioned diseases and problems.

Sources

British National Formulary www.bnf.org

Wikipedia

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