NSAIDs

Non-steroidal anti-inflammatory drugs or NSAIDs are drugs with analgesic (pain-relieving), antipyretic (fever - reducing) and anti-inflammatory effects.

They are sometimes referred to as non-steroidal anti-inflammatory agents/analgesics (NSAIAs).

Common NSAIDs include aspirin and ibuprofen (Advil). Paracetamol has negligible anti-inflammatory activity. It cannot therefore be classified an NSAID.

Uses of NSAIDs

They are commonly used to reduce pain, fever and inflammation. NSAIDs can be prescribed for the treatment of acute or chronic conditions where pain and inflammation are present.

There are ongoing studies into their potential for prevention of colorectal cancer and treatment of other conditions such as cancer as well as cardiovascular diseases.

NSAIDs may be prescribed for the symptomatic relief of the following conditions.

  • Rheumatoid arthritis
  • Osteoarthritis
  • Back pain and sciatica.
  • inflammatory arthropathies (e.g. ankylosing spondylitis, psoriatic arthritis, Reiter's syndrome)
  • Acute gout
  • Strains
  • Rheumatism
  • Postoperative pain
  • Mild-to-moderate pain due to inflammation and tissue injury
  • Pyrexia
  • Renal colic
  • Dysmenorrhoea
  • Metastatic bone pain
  • Headaches and migraines

    NSAIDs Side Effects

    The two main adverse reactions associated with these drugs relate to gastrointestinal effects and renal effects of the agents.

    Because of these side effects, NSAIDs cannot be used in someone with a history of peptic ulcers except in exceptional circumstances and under close medical supervision. These drugs work by preventing the formation of chemicals in the body that cause inflammation (prostaglandins). The body has problems when prostaglandins are inhibited.

    Prostaglandins play a role in maintaining normal function in several organ systems including:

  • The protective lining of the stomach
  • Normal platelet function
  • Kidney blood flow.

    This group of chemicals is also involved in the stomach. NSAIDs therefore tend to cause indigestion as well as duodenal and stomach ulcers.

    NSAIDs can also cause upper gastrointestinal bleeding and death.

    Other common side effects include:

  • High blood pressure
  • Fluid retention
  • Raised liver enzymes
  • Headache
  • Dizziness

    Uncommon side effects include:

  • Heart failure
  • Difficulty breathing
  • Hyperkalaemia (high potassium concentration in the blood)
  • Confusion
  • Bronchospasm
  • Rash
  • Swelling of the face

    NSAIDs cannot be used in the following cases:

  • If you are allergic to aspirin or any NSAID
  • During pregnancy and breast feeding
  • On blood thinning agents (anticoagulants)
  • Suffering from a defect of the blood clotting system (coagulation)
  • If you have active peptic ulcers

    Gastrointestinal Side Effects

    Common gastrointestinal side effects include:
  • Nausea
  • Dyspepsia (pain or an uncomfortable feeling in the upper middle part of your stomach)
  • Ulcers and bleeding
  • Diarrhoea

    Risk of ulcers increases with duration of use and with higher doses. To minimise gastrointestinal side effects, it is important to use the lowest effective dose for the shortest duration possible. Patients often ignore this helpful practice.

    Gastrointestinal adverse effects can be reduced through suppressing acid production, by concurrent use of a proton pump inhibitor such as omeprazole.

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