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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.

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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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