NSAID

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(non-steroidal anti-inflammatory drugs)

A large group of drugs that reduce inflammation. non-steroidal anti-inflammatory drugs act by inhibiting the enzymes (cyclo-oxygenases: COX-1 and COX-2) required for the production of prostaglandins, which are involved in inflammation. They also have analgesic (pain-relieving) activity. non-steroidal anti-inflammatory drugs are used for the long-term treatment of inflammatory rheumatic diseases and back pain; they are particularly appropriate for the relief of chronic pain and stiffness in inflammatory diseases of the joints, such as rheumatoid arthritis. non-steroidal anti-inflammatory drugs are also used to relieve acute pain, such as that occurring after operations or associated with acute gout or heavy periods (in which they reduce the production of prostaglandins that are thought to be responsible for the increased blood flow and painful contractions of the uterus). In cancer patients, non-steroidal anti-inflammatory drugs may reduce the need for opioid analgesics; they are particularly suitable for the pain associated with secondary tumours (metastases) in bones.

Many of the side effects of non-steroidal anti-inflammatory drugs are related to their suppression of prostaglandins, which – in addition to their role in the inflammatory response – also protect the lining of the stomach against attack by gastric acid (see acid-peptic diseases). Therefore many non-steroidal anti-inflammatory drugs have adverse effects on the stomach and intestines (see Side effects below). However, these effects vary in severity with different non-steroidal anti-inflammatory drugs; there is also considerable variation in how individuals respond to the different drugs in this group. It may therefore take a period of 'trial and error' before the non-steroidal anti-inflammatory drug that suits a particular individual is found. COX-2 inhibitors are a subgroup of non-steroidal anti-inflammatory drugs that selectively inhibit cyclo-oxygenase 2 (COX-2) and appear to cause less severe adverse effects on the stomach and intestines. They include celecoxib, etoricoxib, and parecoxib.

non-steroidal anti-inflammatory drugs are available in a variety of forms, including tablets, capsules, modified-release formulations, injections, and suppositories. Some are also available as gels or creams to be applied to the skin to relieve sprains, strains, aches, and pains. Most preparations are prescription only medicines, but some can be obtained without a prescription.

See aceclofenac; acemetacin; azapropazone; benzydamine hydrochloride; dexketoprofen; diclofenac sodium; etodolac; felbinac; fenbufen; fenoprofen; flurbiprofen; ibuprofen; indometacin; ketoprofen; ketorolac trometamol; mefenamic acid; meloxicam; nabumetone; naproxen; nepafenac; piroxicam; sulindac; tenoxicam; tiaprofenic acid; tolfenamic acid.

Side effects:
gastrointestinal effects can include indigestion, nausea, diarrhoea, and occasionally bleeding and ulceration. Indigestion can be prevented by taking non-steroidal anti-inflammatory drugs with milk or food; to reduce the likelihood of bleeding and ulceration, non-steroidal anti-inflammatory drugs can be taken with an antacid, H₂-receptor antagonist, or proton pump inhibitor, or with misoprostol. non-steroidal anti-inflammatory drugs can cause allergic reactions, such as rashes, an asthma attack, or (rarely) swelling of the face and constriction of the airways (see anaphylaxis). Other side effects may include headache, dizziness, vertigo, tinnitus (the sensation of noises in the ear), and sensitivity to sunlight (especially with topical preparations).

Precautions:
non-steroidal anti-inflammatory drugs should not be taken by people who have had allergic reactions to aspirin or other non-steroidal anti-inflammatory drugs (including an asthma attack, itching, or a running nose) or by people who have peptic ulcers, except on medical advice. They should not be taken by women who are pregnant or breastfeeding. non-steroidal anti-inflammatory drugs should only be prescribed for people with a history of peptic ulcers and for elderly people after other treatments have been carefully considered. non-steroidal anti-inflammatory drugs should be used with caution in people who have liver, kidney, or heart disease. Topical non-steroidal anti-inflammatory drugs are usually not recommended for children. They should not come into contact with the eyes, lips, or other mucous membranes or with broken skin. Prolonged exposure of treated skin to sunlight should be avoided.

Interactions with other drugs:

angiotensin-converting enzyme inhibitors: non-steroidal anti-inflammatory drugs may reduce the effect of angiotensin-converting enzyme inhibitors in lowering blood pressure.
Analgesics aspirin should not be taken with other non-steroidal anti-inflammatory drugs and two or more non-steroidal anti-inflammatory drugs should not be taken together, since this is likely to increase their gastrointestinal side effects.
Antibiotics non-steroidal anti-inflammatory drugs may increase the risk of convulsions with quinolones.
Anticoagulants the risk of bleeding may be increased if anticoagulants are taken with non-steroidal anti-inflammatory drugs.
Antidepressants: the risk of bleeding is increased if selective serotonin reuptake inhibitors or venlafaxine are taken with non-steroidal anti-inflammatory drugs.
Antidiabetic drugs: non-steroidal anti-inflammatory drugs may enhance the effects of the sulphonylureas.
Ciclosporin: there is an increased risk of kidney damage if ciclosporin is taken with non-steroidal anti-inflammatory drugs.
Diuretics the risk of kidney damage is increased if diuretics are taken with non-steroidal anti-inflammatory drugs.
Erlotinib increases the risk of bleeding if taken with non-steroidal anti-inflammatory drugs.
Lithium its excretion is reduced by non-steroidal anti-inflammatory drugs, so that it builds up in the bloodstream and is more likely to cause adverse effects.
Methotrexate its excretion is reduced by non-steroidal anti-inflammatory drugs, so that it builds up in the bloodstream and is more likely to cause adverse effects.
Phenytoin its effects may be increased if taken with non-steroidal anti-inflammatory drugs.
Probenecid may increase the effects of non-steroidal anti-inflammatory drugs.
Tacrolimus there may be increased risk of kidney damage if this drug is taken with non-steroidal anti-inflammatory drugs.

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n.pl

The acronym for nonsteroidal antiinflammatory drugs. See also naproxen.