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Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAIDs.
They reduce pain,fever and, in higher doses, inflammation. The term “non-steroidal” is used to distinguish these drugs from steroids The most well known members of this group of drugs are asprin , ibuprofen, and naproxen partly because they are available over-the-counter. Examples of coxibs include celecoxib (brand name Celebrex) and etoricoxib (Arcoxia).
Paracetamol (acetaminophen) is not an NSAID because although it is an antipyretic and analgesic, it is not an anti-inflammatory.
NSAIDs are usually used for the treatment of acute or chronic conditions where pain and inflammation are present They have no long-term effect on the disease. They are often taken in addition to simple painkillers Usually a low dose is prescribed initially, and then increased if necessary.
For any patient who is prescribed NSAIDs (including coxibs), doctors have been advised to use the lowest effective dose for the shortest period of time.
Some NSAIDs, such as aspirin and ibuprofen, are available without prescription. It is unwise to take more than one NSAID at any one time, and some people should not take NSAIDs at all. Do not take any other over-the-counter preparations without discussing this first with your doctor, or pharmacist.
Side-effects of all NSAIDs include stomach upsets, heartburn, indigestion, nausea/vomiting, stomach ulcers or bleeding, diarrhoea, dizziness, rashes, headaches, wheeziness.salt and fluid retention.high blood pressure, kidney diseases, and photosensitivity
NSAIDs can damage the lining of the stomach and cause bleeding, particularly if taken in higher doses or over a long period of time. NSAIDs are never to be used in individuals with Chrohns Disease or Ulcerative Colitis) due to its tendency to cause gastric bleeding and form ulceration in the gastric lining.
These effects are dose-dependent, and in many cases severe enough to pose the risk of ulcer perforation, upper gastrointestinal bleeding, and death, limiting the use of NSAID therapy.
Some doctors prescribe drugs known as proton-pump inhibitors along with standard NSAIDs to help reduce the side-effects on the stomach.
An estimated 10-20% of NSAID patients experience gut disturbance. NSAID-associated upper gastrointestinal adverse events are estimated to result in 103,000 hospitalizations and 16,500 deaths per year in the United States, and represent 43% of drug-related emergency visits. Many of these events are avoidable; a review of physician visits and prescriptions estimated that unnecessary prescriptions for NSAIDs were written in 42% of visits. (Green, 2001)
Ibuprofen may also rarely cause IBS symptoms. In very rare cases, ibuprofen can cause aseptic meningitis. Most NSAIDs penetrate poorly into the nervous system (CNS). However, the COX may cause adverse effects such as somnolence and dizziness
Doctors have also been advised to be cautious about prescribing coxibs to people who have an increased risk of heart disease, such as people with high blood pressure, high cholesterol levels (hyperlipidaemia) or diabetes, or people who smoke. Some standard NSAIDs have also been shown to be associated with a small increased risk of heart attack and stroke, especially when used in high doses and for long periods. Your doctor should take these risks into account and may be cautious in prescribing standard NSAIDs if you have heart disease, a history of stroke or peripheral vascular disease, or if you are at high risk of these diseases. Information regarding this possible increased risk is currently being researched.
NSAIDs aside from aspirin are associated with a doubled risk of symptomatic heart failure in patients without a history of cardiac disease. In patients with such a history, however, use of NSAIDs (aside from low-dose aspirin) was associated with more than 10-fold increase in heart failure.If this link is found to be causal, NSAIDs are estimated to be responI sible for up to 20 percent of hospital admissions for congestive heart failure.The coxibs have recently been linked to increased risks of heart attack and stroke. Although the increased risk is small, you should not take coxibs if you have heart disease, if you have had a heart attack or stroke in the past, or if you have peripheral vascular disease (circulation problems in the limbs, usually in the legs). You should not take etoricoxib if you have high blood pressure which is not under control.
A recent meta-analysis of all trials comparing NSAIDs found an 80% increase in the risk of myocardial infarction with both newer COX-2 antagonists and high dose traditional anti-inflammatories compared with placebo. (Kearney et al., BMJ 2006;332:1302-1308)
If you develop any new symptoms you should stop taking the drug and report to your doctor as soon as possible
NSAIDs should therefore only be used with caution and only continue to be used if they are controlling your symptoms. You should not take them if you have a history of indigestion or stomach ulcers
Caution is required in the use of NSAIDs if you have asthma, high blood pressure, heart disease or kidney problems or take warfarin. Your doctor should advise you about this.
Coxibs can cause serious, and sometimes fatal, skin reactions, although these reactions are rare. If you are concerned about your medication or if you need more information, talk to your doctor or rheumatology nurse.
Some other drugs, e.g. warfarin, interact with NSAIDs, so you should discuss any new medications with your doctor before starting them, and you should always tell any other doctor treating you that you are taking NSAIDs.
You should not take NSAIDs if you are allergic to aspirin. Discuss this with your doctor.
NSAIDs are not generally recommended during pregnancy. If you are planning a family or become pregnant you should discuss this with your doctor as soon as possible. Some recent studies suggest that NSAIDs taken around the time of conception may increase the risk of miscarriage. Paracetamol does not have this effect.
Some NSAIDs should not be taken while breastfeeding. Again, discuss this with your doctor.
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