Non Steroidal Anti-Inflammatory Drug (medication) is abbreviated as NSAIDs. NSAIDs are non-addictive analgesics. Few NSAIDs like Aspirin, Ibuprofen and Naproxen are sold without doctor's prescription and are available on counter. NSAIDs blocks actions of enzyme COX-1 and 2 at peripheral and central nervous system. NSAIDs are divided in two groups as follows-

What Are NSAIDs

  • Cox-1 enzyme inhibitors
  • Cox-2 enzyme inhibitors

NSAIDs are Prescribed For Following Symptoms-

Anti-inflammation- NSAIDs are anti-inflammatory and prevents the symptoms like pain and fever caused by inflammation.

Analgesics- Acute and chronic pain is treated with NSAIDs. Opioids are alternative to NSAIDs as analgesics. NSAIDs do not cause addiction. NSAIDs blocks prostaglandin.

Antipyeretic- NSAIDs are prescribed for fever. NSAIDs are widely used to treat fever. Dosage has to be watched in children and infants.

Indications For NSAIDS Treatment-

Joint Pain-

  • Arthritis
    • Rheumatoid Arthritis- Inflammatory joint disease
    • Osteoarthritis- Degenerative arthritis
    • Psoriatic Arthritis
    • Facet Joint Arthropathy- Causes backache
    • Gout
    • Pseudogout
  • Traumatic Arthritis

Muscular Pain

  • Inflammatory Disease
    • Fibromyalgia
    • Myofascial Disease
  • Muscular Injury-
    • Muscle Tear

Tendonitis

  • Inflammation of Tendon
    • Tennis Elbow
    • Tendonitis
  • Injury or Trauma-
    • Tendon Tear

Risk Factors Of NSAIDS-

  • Long Term Use-
    • Most of the side effects and complications are observed following long term use of NSAIDs.
  • Drug Interaction-
    • Diuretics- Diuretics when prescribed with NSAIDs causes kidney damage as a result of decreased renal blood flow.
    • Lithium- Decreases excretion of lithium
    • Methotrexate- Decreases elimination or excretion of methotrexate.
    • Warfarin- Increases tendency to bleed by decreasing coagulability.
  • Allergies- Observed in few cases during treatment and not recognized.
  • Hypertension- Interferes with antihypertensive medication and results in resistance to effects if antihypertensive treatment.
  • Family History- Chances of developing peptic ulcer following NSAIDs consumption is high in patient with family history of similar disease.

Side Effects Of NSAIDS-

  • Allergies- Hives and shortness of breath is observed in few cases.
  • Histamine Reaction- Swelling of face, lips, or throat caused by allergies.
  • Dyspepsia- Belching and feeling of distension of stomach is observed after 2 to 3 weeks of treatment.
  • Ulcer- Stomach and duodenal ulcer develops within 72 hours in susceptible cases. Average in most of the cases peptic ulcer symptoms are observed after 3 to 4 weeks of treatment.
  • Perforation- Stomach or duodenal ulcer may perfprate through the wall of the stomach and duodenum.
  • Blood Clotting- NSAIDs interferes with blood clotting and results in blood thinning.
  • Cerebral Hemorrahge- Bleeding in brain either subdural or intracerebral bleeding may result following either rupture of aneurysm or capillaries.

Complications of NSAIDs

  • Allergies- Life threatening allergies may result if initial symptoms is ignored.
  • Blood Loss- Ulcer may cause perforation of mucosal blood vessels and arterial blood vessel results in continuous arterial bleeding and substatial blood loss.
  • Peritonitis- Perforation of wall of the stomach and duodenum may result in peritonitis. Peritonitis is associted with inflammation and infection of peritoneum.
  • Myocardial Infarction- Results in heart attack.
  • Stroke- Results after bleeding within brain.
  • Erectile Dysfunction- The irregularities in blood supply to cavernous tissue causes erectile dysfunction.

NSAIDs Contraindicated-

  • Bleeding disorder
  • History of peptic ulcer
  • Cerebral (brain) aneurysm
  • Irritable bowel syndrome
  • Hypertension not responding to treatment
  • Kidney disease
  • History of transient ischemic attack (TIA) and stroke
  • History of myocardial infarction and cardiac surgery

Classification of NSAIDs

NSAIDs are classified according to biochemical structures of the molecule. There are over 40 NSAIDs sold in USA. Most of the NSAIDs need physician prescriptions.

NSAIDs of COX-2 inhibitors cause less side effects such as peptic ulcer and dyspepsia than COX-1 inhibitors.

NSAIDs are Classified In Following Group-

COX 1 Inhibitors-

  1. Salicylates
  2. Propionic acid
  3. Acetic acid
  4. Anolic acid
  5. Anthranilic acid
  6. Sulphonamide

Selective Cox 2 Inhibitors Celecoxib

Most Commonly Used and Prescribed NSAIDs are as Follows-

Cox-1 Inhibitors-

  • Salicylates-
    • Aspirin
    • Diflunisal (Dolobid)
  • Propionic Acid
    • Ibuprofen (motrin)
    • Naproxen
  • Acetic acid
    • Indomethacin
    • Sulindac
  • Anthranilic Acid
    • Mefanamic acid
    • Flufenamic acid
  • Enolinic Acid
    • Piroxicam
    • Meloxicam
  • Sulfonamides-
    • Nimesulide

Cox 2 Inhibitos

  • Celecoxib (Celebrex)

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: November 9, 2015

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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