Non-steroidal anti-inflammatory agent
Non-steroidal anti-inflammatory agents, also called non-steroidal anti-inflammatory drugs (NSAIDs) are defined as "anti-inflammatory agents that are not steroids. In addition to anti-inflammatory actions, they have analgesic, antipyretic, and platelet-inhibitory actions. They are used primarily in the treatment of chronic arthritic conditions and certain soft tissue disorders associated with pain and inflammation. They act by blocking the synthesis of prostaglandins by inhibiting cyclooxygenases, which convert arachidonic acid to cyclic endoperoxides, precursors of prostaglandins. Inhibition of prostaglandin synthesis accounts for their analgesic, antipyretic, and platelet-inhibitory actions; other mechanisms may contribute to their anti-inflammatory effects. Certain NSAIDs also may inhibit lipoxygenase enzymes or phospholipase C or may modulate T-cell function."
The clinical characteristics of NSAISs have been reviewed.
In general, they have been too toxic for veterinary medicine, although there is now limited use in dogs and extremely limited use in cats. Meloxicam, for example, is approved only for a single post-surgical dose in cats, but is used off-label in cancer treatment. One of the attractions of NSAIDs here is that they appear to inhibit some cancers, such as squamous cell carcinoma that expresses cyclooxygenase 1. Nevertheless, they can cause sudden and life-threatening reactions, such as gastric bleeding.
Non-selective inhibitors of cyclooxygenase
Selective inhibitors of cyclooxygenase 2
More selective inhibitors, which do not suppress COX-1 and thus are less likely to result in gastric irritation, seemed extremely promising until postmarketing surveillance indicate that they increase the risk of serious cardiac events. Only one remains on the market in the United States. There are reports, however, that COX-2 inhibitors can relieve pain that other NSAIDs do not.
COX-inhibiting nitric oxide donator (CINOD)
Risk factors for developing dyspepsia with NSAIDs are:
- prior history of dyspepsia
- prior UGI complication
- age 65
Peptic ulcer disease
NSAIDs may contribute to gastrointestinal ulceration including peptic ulcer disease. A meta-analysis concluded "ibuprofen was associated with the lowest relative risk, followed by diclofenac. Azapropazone, tolmetin, ketoprofen, and piroxicam ranked highest for risk and indomethacin, naproxen, sulindac, and aspirin occupied intermediate positions. Higher doses of ibuprofen were associated with relative risks similar to those withnaproxen and indomethacin."
- "All patients regardless of risk status who are about to start long-term traditional NSAID therapy should be considered for testing for H. pylori and treated, if positive."
Damage from NSAIDS may rarely occur after just a few doses.
Combined with acetaminophen
For lumbalgia, acetaminophen one gram orally four times a day combined with diclofenac, a non-steroidal anti-inflammatory agent, was not better than acetaminophen alone in a randomized controlled trial.
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- The American Geriatrics Society - Education - AGS Clinical Practice Guideline: Pharmacological Management of Persistent Pain in Older Persons.
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- Lanza FL, Chan FK, Quigley EM, Practice Parameters Committee of the American College of Gastroenterology (2009). "Guidelines for prevention of NSAID-related ulcer complications.". Am J Gastroenterol 104 (3): 728-38. DOI:10.1038/ajg.2009.115. PMID 19240698. Research Blogging.
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