Non-Steroidal Anti-Inflammatory Drug (NSAID)
Non-steroidal anti-inflammatory drugs (NSAIDs) relieve pain, reduce inflammation and lower fever without containing steroids. They are among the most widely used medications worldwide.
Things worth knowing about "Non-Steroidal Anti-Inflammatory Drug"
Non-steroidal anti-inflammatory drugs (NSAIDs) relieve pain, reduce inflammation and lower fever without containing steroids. They are among the most widely used medications worldwide.
What are Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)?
Non-steroidal anti-inflammatory drugs (NSAIDs) are a class of medications that reduce inflammation, relieve pain, and lower fever. Unlike corticosteroids (cortisone-based drugs), they do not contain a steroid structure – hence the term non-steroidal. NSAIDs are among the most frequently used medications worldwide and are available both over the counter and by prescription.
Mechanism of Action
NSAIDs work by inhibiting the enzyme cyclooxygenase (COX), which exists in two forms: COX-1 and COX-2. This inhibition reduces the production of prostaglandins – signaling molecules that promote inflammation, pain, and fever.
- COX-1 is constitutively active and helps protect the stomach lining and maintain kidney function.
- COX-2 is mainly induced during inflammation and is primarily responsible for pain and fever.
Non-selective NSAIDs inhibit both enzymes, whereas selective COX-2 inhibitors (known as coxibs, e.g., celecoxib) specifically target COX-2, resulting in a lower risk of gastrointestinal side effects.
Indications – When are NSAIDs Used?
NSAIDs are used for a wide range of conditions and symptoms:
- Acute and chronic pain (e.g., headaches, toothaches, back pain)
- Inflammatory joint diseases such as rheumatoid arthritis and osteoarthritis
- Sports injuries and muscle pain
- Fever
- Menstrual pain (dysmenorrhea)
- Inflammatory conditions such as gout, bursitis, or tendinitis
- Ankylosing spondylitis
Key Active Substances
The most well-known NSAIDs include:
- Ibuprofen – widely available over the counter, well tolerated at low doses
- Diclofenac – potent anti-inflammatory, also available as a topical gel
- Naproxen – longer duration of action, taken less frequently
- Acetylsalicylic acid (aspirin) – also used as a blood thinner
- Indomethacin – highly potent, commonly used for gout
- Celecoxib, Etoricoxib – selective COX-2 inhibitors with lower gastrointestinal risk
Dosage and Administration
Dosage depends on the specific active substance, the indication, and the individual patient profile. As a general principle, NSAIDs should be taken at the lowest effective dose for the shortest duration necessary. Long-term use should be supervised by a healthcare professional.
To minimize stomach irritation, NSAIDs should ideally be taken with food. In patients with a high gastrointestinal risk, a proton pump inhibitor (PPI) may be co-prescribed.
Side Effects
Despite their widespread use, NSAIDs can cause significant side effects:
- Gastrointestinal issues: nausea, stomach irritation, ulcers, and bleeding
- Kidney impairment: especially with prolonged use or in patients with pre-existing conditions
- Cardiovascular risks: increased risk of heart attack and stroke (particularly with COX-2 inhibitors and high doses)
- Elevated blood pressure
- Allergic reactions: skin rash, asthma attacks (NSAID intolerance)
- Liver dysfunction (rare)
Contraindications
NSAIDs should not be used in patients with:
- Known stomach ulcers or active gastrointestinal bleeding
- Severe renal or hepatic insufficiency
- Pregnancy (especially from the third trimester onward)
- Known hypersensitivity or NSAID intolerance
- Severe heart failure
Drug Interactions
NSAIDs can interact with various other medications:
- Anticoagulants (e.g., warfarin, heparin): increased bleeding risk
- Antihypertensives: reduced blood pressure control
- Corticosteroids: increased risk of gastrointestinal bleeding
- Other NSAIDs or aspirin: intensified side effects
- Lithium and methotrexate: elevated drug levels and toxicity
References
- World Health Organization (WHO): Model Formulary – Analgesics and Non-Steroidal Anti-Inflammatory Medicines. www.who.int
- Brunton L.L., Hilal-Dandan R., Knollmann B.C.: Goodman & Gilman's The Pharmacological Basis of Therapeutics. 13th Edition, McGraw-Hill, 2018.
- Vane J.R., Botting R.M.: Anti-inflammatory drugs and their mechanism of action. Inflammation Research, 1998; 47(2): 78-87.
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