NSAIDs: Relieve pain and inflammation and lower fever

NSAIDs stands for "non-steroidal anti-inflammatory drugs". Doctors use these widely available and frequently used medicines on a large scale to relieve pain, swelling and inflammation in all kinds of disorders and to reduce fever. Aspirin and ibuprofen are some names of well-known freely available NSAIDs. More powerful NSAIDs are only available on prescription. But with these prescribed drugs some side effects are possible in some patients and that is why the doctor usually tries out other treatment methods or drugs first. NSAIDs exist in two forms, each with their own effect, side effects and risks.

Operation of medicines

NSAIDs block the effects of an enzyme (a protein that causes changes in the body) in the body. This enzyme, known as cyclooxygenase or COX, has two forms. COX-1 protects the stomach wall from aggressive acids and digestive chemicals. It also helps with proper kidney function. The production of COX-2 occurs when joints are injured or inflamed.

Traditional NSAIDs

Traditional NSAIDs, also known as non-selective NSAIDs, block the actions of both COX-1 and COX-2. As a result, they often cause side effects such as upset stomach and bleeding while relieving pain and inflammation. Aspirin, an example of a traditional NSAID, has a number of advantages over other NSAIDs. Aspirin works against the formation of blood clots. The patient therefore has less chance of forming clots that lead to heart attacks and strokes.
Examples of traditional NSAIDs
  • Aspirin (high dose)
  • Diclofenac
  • Etoricoxib
  • Ibuprofen
  • Indocin / Indometacin
  • Mefenamic acid
  • Naprosyn / naproxen
  • Oxaprozin / Daypro
  • Piroxicam / Feldene
  • Vimovo
  • Voltaren

COX-2 inhibitors

COX-2 inhibitors, also known as selective NSAIDs, are a special category of NSAIDs. These drugs are only aimed at the COX-2 enzyme that stimulates the inflammatory response. Because they do not block the actions of the COX-1 enzyme, these drugs generally do not cause stomach problems or bleeding that the traditional NSAIDs have as a side effect. This makes them suitable for use in chronic conditions such as arthritis (joint inflammation). COX-2 inhibitors, which are usually somewhat more expensive than traditional NSAIDs, do not offer the same type of protection against heart attacks and strokes.
Examples of COX-2 inhibitors
  • Arcoxia / Etoricoxib
  • Celebrex / Celecoxib
  • Valdecoxib
  • Vioxx / Rofecoxib

Indication: Relieve pain and inflammation and lower fever

This medication, which does not belong to the corticosteroid group, is used by the doctor to treat symptoms of headache, painful periods, sprains and strains, colds (mild infection with symptoms of the nose and throat) and flu, arthritis, bursitis, tendinitis (tendon inflammation) , relieve Bechterew's disease and other causes of long-term pain. NSAIDs also lower the fever.

Contraindication for non-steroidal anti-inflammatory drugs

NSAIDs can be taken by most patients, but in some patients the doctor is careful to prescribe this and he opts faster for an alternative such as acetaminophen. When using NSAIDs, the risk of side effects increases with certain target groups. This applies to the following patients:
  • patients taking certain medications that interact with NSAIDs
  • patients who had an allergic reaction to an NSAID in the past
  • patients who have had stomach ulcers in the past
  • patients younger than 16 years (aspirin is not recommended in children below this age)
  • patients older than 65 years
  • patients with asthma
  • Patients with heart, liver, kidney, blood pressure, circulatory or intestinal problems
  • women who are (possibly) pregnant
  • breastfeeding women

Side effects and effects of NSAIDs

Every medicine, including NSAIDs, has potential side effects. These are more common when the patient takes high doses or takes this medication for a long time. Older patients or patients with long-term weak (er) health also run a higher risk of side effects. NSAIDs that are available on prescription are more powerful and therefore more often give more side effects than freely available NSAIDs.
Possible side effects of NSAIDs that occur in approximately 10 to 50% of patients include:
  • allergic reactions
  • heartburn and upset stomach
  • stomach ache
  • constipation
  • diarrhea
  • dizziness
  • elevated blood pressure (hypertension)
  • a cavity in the wall of the stomach or intestines
  • a rash
  • a bloated feeling
  • decreased appetite
  • swollen feet
  • headache
  • bleed longer after an injury or operation
  • gastric ulcers: When these bleed internally, they lead to anemia (medical term: anemia); additional drugs, such as proton pump inhibitors (drugs that reduce stomach acid) (PPI) reduce this risk
  • nausea
  • liver, kidney problems (renal failure (reduced or absent kidney function)) or heart and circulatory system (heart failure, heart attacks and strokes) (rare)
  • sleepiness
  • tinnitus aurium (ringing in the ears: this mainly occurs with the use of high doses of aspirin)
  • ulcers (ulcers)

Interactions with other medicines

Some NSAIDs react unpredictably to other medicines. This may make the medication less effective and increase the risk of side effects. It is especially important to seek medical advice before using an NSAID when the patient is taking the following medication:
  • ciclosporin: a medicine that the doctor uses to treat autoimmune disorders such as arthritis or ulcerative colitis (chronic bowel disease with diarrhea, abdominal pain and painful bowel movements)
  • diuretics: moisturizing medicines / water pills: medicines that the doctor uses to treat high
  • COX-2 inhibitors: with this form of NSAID, the patient does not take any other freely available NSAID
  • another NSAID
  • a low dose of aspirin or Warfarin (anticoagulants: blood thinners)
  • lithium: a medicine that the doctor prescribes for the treatment of bipolar disorder (mental illness: mood disorder with (hypo) manic (high) and depressive (low) periods) and severe depression
  • methotrexate: a medicine for the treatment of rheumatoid arthritis (chronic autoimmune disease with inflammation of joints and other organs)
  • selective serotonin reuptake inhibitors (SSRIs): a type of medicine for depression

Use of medication: With food and without alcohol

NSAIDs are available as tablets, capsules, suppositories (capsules inserted into the anus), creams, gels and injections. Some NSAIDs are freely available, while others require a doctor's prescription. The patient should read the enclosed leaflet, which states whether he should avoid certain foods and drinks. The doctor and pharmacist also advise the patient on this. Normally the patient can still eat anything. Drinking alcohol in combination with NSAIDs may harm the stomach so it is not recommended. The patient also takes an NSAID with food or a glass of milk.

Alternatives to NSAIDs

Since NSAIDs sometimes cause unpleasant side effects, it is better to first try an alternative such as the freely available painkiller "paracetamol". Furthermore, in the case of muscle pain or joint pain in a specific part of the body, the patient should first use NSAID creams and gels that he rubs on the skin. These usually cause fewer side effects than the tablets or capsules. Physiotherapy or other forms of therapy are also possible with some medical conditions. The doctor always looks at this carefully and discusses it extensively with the patient.

Video: Non steroidal anti-inflammatory drugs NSAIDs: Mayo Clinic Radio (April 2020).

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