Non-steroidal Anti-inflammatory Drugs (NSAIDs)
Non-steroidal anti-inflammatory drugs are very common because they have very strong analgesic properties and can also be bought without a prescription.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to relieve pain, lower fever, and reduce inflammation. They also have anti-platelet properties.
Many use nonsteroidal anti-inflammatory drugs without a doctor’s prescription because they are sold over the counter at pharmacies. However, it should be taken into account that these drugs have side effects and that medical advice is always necessary.
There is no drug within the NSAID group that is better or safer. Therefore, these drugs should never be taken in combination with other drugs without medical advice. Because unforeseen interactions could cause problems.
How do nonsteroidal anti-inflammatory drugs work?
Orally administered nonsteroidal anti-inflammatory drugs are absorbed through the gastrointestinal tract and then enter the bloodstream. There they mostly bind to the plasma protein albumin. This is important as the dose of the drug needs to be adjusted in case of hypoalbuminemia. Otherwise the concentration of free drug molecules in the blood is too high and therefore the effect is stronger.
The free drug molecules have analgesic and anti-inflammatory effects, but how? These drugs are characterized by different mechanisms of action, which work as follows:
- Inhibition of the enzyme cyclooxygenase (COX): This is the main mechanism of action of NSAIDs. By inhibiting this enzyme, the pain and inflammatory reactions caused by prostaglandins are reduced.
- Effects that are not related to prostaglandins, such as the inhibition of neutrophils or inflammatory mediators such as nitric oxide under the influence of cytokines.
- Apoptosis: Prostaglandins inhibit apoptosis (programmed cell death) and this may explain, at least in part, why certain nonsteroidal anti-inflammatory drugs are associated with a reduced risk of certain types of cancer.
Nonsteroidal anti-inflammatory drugs: classification
In the group of non-steroidal anti-inflammatory drugs, a distinction is made between non-selective NSAIDs and selective COX-2 inhibitors.
The following drugs belong to the family of non-selective NSAIDs:
- Acetylsalicylic acid: aspirin
- Pyrazolones : metamizole
- Aminophenols : paracetamol
- Arylpropionic acid derivatives : ibuprofen
- Acetic acid derivatives : indomethacin
- Oxicame : piroxicam
- Anthranilic acid derivatives : mefenamic acid
The selective COX-2 inhibitors include, for example, meloxicam, nimesulide, etodolac and coxibs such as celecoxib.
NSAIDs: pharmacokinetics
These drugs are quickly absorbed. It is administered orally, but there are also topical, intravenous and rectal formats. After absorption, the concentration in the blood reaches its maximum values after approximately two to three hours.
It is advisable to take nonsteroidal anti-inflammatory drugs in combination with food, as they can otherwise damage the intestinal lining.
Most of the drugs in this group have very high levels of binding to the plasma protein albumin (between 95 and 99 percent). This is important to consider because this strong bond can lead to many interactions with other drugs that have similar properties.
NSAIDs are metabolized in the liver and some have active metabolites. Almost all of them go through the enterohepatic cycle to some degree. After being metabolized, the drugs are excreted through the kidneys. Therefore, patients with renal insufficiency need to be careful, the dose must be precisely adjusted.
Side effects
All drugs have side effects. It is therefore important to be familiar with them and to clarify the risks with the doctor.
Nonsteroidal anti-inflammatory drugs , in particular, have negative effects on the gastrointestinal area. This often leads to the ingestion not being followed properly. They are also harmful to the kidneys.
Other possible side effects are:
- high blood pressure
- Heart trouble
- Rashes
- Fluid retention
So don’t forget that you should always consult a doctor before taking these medicines. It is also important to know the side effects and to use the medication properly so that it can achieve its goal.
