L15.NSAIDS

Step 11: Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

  • Nonsteroidal Anti-inflammatory Drugs (NSAIDs) are a drug class that decreases pain, fever, and inflammation. They differ from acetaminophen, which treats pain and fever alone.

Types of NSAIDs

  • Salicylate NSAIDs

    • Aspirin

      • Trade Names: Bayer, Ecotrin

    • Salsalate

      • Trade Name: Disalcid

  • Cyclooxygenase-2 Inhibitors

    • Celecoxib

      • Trade Name: Celebrex

  • Non-Salicylate NSAIDs

    • Naproxen

      • Trade Names: Aleve, Naprosyn

    • Meloxicam

      • Trade Name: Mobic, Vivlodex

    • Ibuprofen

      • Trade Names: Advil, Midol, Motrin, Nuprin

Salicylates

  • The oldest NSAIDs, first discovered in 1829 from willow bark.

  • Aspirin was trademarked by Bayer in 1899.

  • Commonly used salicylates have analgesic and antipyretic effects:

    • Analgesic: Relieves pain

    • Antipyretic: Reduces fever

  • Salicylates inhibit platelet aggregation, providing a "blood-thinning" effect to help prevent heart attacks.

Adverse Effects of Salicylates

  • Common side effects include:

    • Nausea, vomiting, and diarrhea

    • Stomach ulcers (especially at high doses)

    • Allergic reactions (rash or edema) which can lead to anaphylactic shock

Reye Syndrome

  • A rare, serious illness affecting the brain and liver, most common in children recovering from a viral infection.

  • Linked to the use of aspirin or salicylates during viral diseases, leading to a recommendation against their use in children.

  • The term "baby aspirin" refers to low-dose (81 mg) aspirin, not intended for infants.

  • Salicylates interact favorably with caffeine, enhancing analgesic effects when combined (found in products like Excedrin and Anacin).

  • Patients should avoid alcohol, as it can exacerbate ulcerations when combined with salicylates.

Cyclooxygenase-2 Inhibitors

  • These NSAIDs prevent the formation of prostaglandins, which are hormone-like compounds that promote inflammation and pain (COX-2).

  • COX-1 maintains normal organ function; inhibition can cause side effects.

  • Most general NSAIDs inhibit both COX-1 and COX-2, which can lead to more side effects.

  • Some NSAIDs selectively inhibit only COX-2, primarily relieving inflammation without impacting COX-1.

Usage and Side Effects

  • Cyclooxygenase-2 inhibitors are mainly for relieving inflammation, not minor aches or fevers.

  • Possible adverse effects:

    • Heartburn, edema, back pain, flu-like symptoms.

    • Increased risk of heart attack highlighted.

  • Advantage: Can be used with low doses of aspirin without interaction.

  • Contraindications: Do not use with arthritis drugs or sulfonamides.

Nonsalicylate NSAIDs

  • Derived from propionic, acetic, and anthranilic acids.

  • Effectiveness varies among patients; if one NSAID fails, another may succeed.

  • Like other NSAIDs, they inhibit prostaglandin synthesis.

Side Effects and Precautions

  • Gastrointestinal distress is common, with risks for ulcers.

  • Avoid taking with other over-the-counter pain relievers:

    • Ibuprofen and aspirin negate each other's effects.

    • Naproxen and ibuprofen are not recommended for asthma patients.

    • Do not combine with anticoagulants (e.g., heparin) due to increased bleeding risk.