NSAID’s or nonsteroidal anti-inflammatory drugs are medications we commonly use to treat fever, pain, and inflammation. They are among the most popular medications in world, which we can buy with a prescription or OTC. OTC, which stands for over-the-counter, refers to medications that we can purchase without a doctor’s prescription. Aspirin, for example, a type of NSAIDs, is an OTC drug.
Although they are extremely popular, NSAIDs are not suitable for everybody, and can sometimes cause unpleasant side effects.
According to the US National Institutes of Health:
“NSAIDs are one of the most commonly prescribed classes of medication for pain and inflammation. They are responsible for approximately 5-10% of all medications prescribed each year. The prevalence of NSAID use in patients over 65 years old is as high as 96% in the general practice setting.”
Types of NSAIDs
There are two main categories of nonsteroidal anti-inflammatory drugs: non-selective NSAIDs and selective COX-2 inhibitors.
Non-selective NSAIDs
These medications inhibit both COX-1 and COX-2 enzymes. These enzymes are responsible for the production of prostaglandins, which are lipid compounds that contribute to inflammation, pain, and fever. Below are some of the most common non-selective NSAIDs:
- Aspirin
- Diclofenac
- Ibuprofen
- Indomethacin
- Naproxen
Selective COX-2 inhibitors
These medications target the COX-2 enzyme specifically, thus reducing the risk of gastrointestinal side effects. Gastrointestinal refers to the stomach and the intestines. Two common COX-2 inhibitors are:
- Etoricoxib
- Celecoxib
Mechanism of Action
Nonsteroidal anti-inflammatory drugs work by inhibiting COX or cyclooxygenase enzymes, which play a vital role in the production of prostaglandins, which contribute to inflammation, pain, and fever.
Clinical Uses of NSAIDs
We use these drugs to manage a variety of illnesses and conditions, including:
- Inflammation
NSAIDs can help reduce inflammation in conditions like gout, ankylosing spondylitis, osteoarthritis, and rheumatoid arthritis.
- Pain relief
These drugs can effectively tread both acute and chronic pain, such as toothache, menstrual cramps, musculoskeletal pain, and headache. In medicine, chronic means long-term. The opposite of chronic is acute (short-term).
- Cardiovascular uses
Regular low doses of aspirins can help reduce the risk of developing heart attacks and strokes in at-risk patients.
- Pyrexia
Pyrexia means fever (high temperature). NSAIDs are commonly used for people with high temperatures.
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Risks and side effects
When used appropriately, NSAIDs are generally safe. However, they can cause side effects, especially if you take them regularly over a long period or in high doses.
The most common side effects are:
- Allergic reactions
They may trigger asthma exacerbations in susceptible individuals, and in rare cases, anaphylaxis. Anaphylaxis is a severe and potentially life-threatening allergic reaction.
- Gastrointestinal
Some patients may experience gastrointestinal bleeding, ulcers, and dyspepsia (indigestion).
- Kidneys
Extended use may lead to acute kidney injury or chronic kidney disease.
- Cardiovascular
COX-2 inhibitors may increase the risk of elevated blood pressure (hypertension), heart failure, heart attacks, and stroke.
Precautions and Contraindications
If you are pregnant, a lactating mother (breastfeeding mom), elderly, or have a pre-existing condition, check with your doctor before taking any of these medications. Let them know what current medications you are taking.
According to the UK’s National Health Service:
“Most people can take NSAIDs, but some people need to be careful about taking them. It’s a good idea to ask a pharmacist or doctor for advice before taking an NSAID if you: are over 65 years of age, are pregnant or trying for a baby, are breastfeeding, have asthma, have had an allergic reaction to NSAIDs in the past, have had stomach ulcers in the past, have any problems with your heart, liver, kidneys, blood pressure, circulation or bowels, are taking other medicines, are looking for medicine for a child under 16 (do not give any medicine that contains aspirin to children under 16).”