Non-steroidal Anti-inflammatory Drugs: Types And Effects
Non-steroidal anti-inflammatory drugs, also known by the acronym NSAID, are drugs with analgesic, antipyretic, anti-inflammatory and antiplatelet properties.
NSAIDs are among the most widely used drugs worldwide. Due to their analgesic effect, they are used in the treatment of rheumatic pains, inflammatory and degenerative diseases. They are also indicated for disorders such as migraines, toothaches and in general in any inflammatory process.
Their use is also extremely widespread in the form of self-medication. These are drugs that are not subject to prescription and medical supervision, which is why they present a potential risk of side effects.
It is equally important to emphasize that among non-steroidal anti-inflammatories there is no better or safer product than another and that they should not be taken in conjunction with other prescription drugs, as they can cause interactions.
How do non-steroidal anti-inflammatories work?
During the metabolism process in the liver, non-steroidal anti-inflammatories bind to a high percentage of a plasma protein called albumin.
This aspect is extremely important, since if the patient is in a condition of hypoalbuminemia, the dose of the drug will have to be adjusted; this is because there will be more free drug in the blood than protein bound, so the effect will be greater.
It is the free fraction of the drug that triggers the effects of non-steroidal anti-inflammatories ; but how? The mechanism of action of the drug is not unique and its function can be activated in the following ways:
- By inhibiting the cyclooxygenase (COX) enzyme : this is the main mechanism. Inhibition of this enzyme prevents the synthesis of prostaglandins, substances that act as mediators of inflammation.
- Effects not mediated by prostaglandins, such as inhibition of neutrophils in inflammation or inhibition of proinflammatory mediators such as cytokine-induced nitric oxide.
- Apoptosis : Prostaglandins inhibit apoptosis and this explains at least in part why some NSAIDs are linked to a lower risk of developing certain cancers.
Classification of NSAIDs
Non-steroidal anti-inflammatory drugs can be classified according to the selectivity or not of COX-2. On the one hand there are non-selective NSAIDs and on the other those selective for COX-2. Among the non-selective we have the following groups:
- Salicylates : acetylsalicylic acid or aspirin.
- Pyrazolones : metamizole.
- Paraaminophenols : paracetamol.
- Propionic acid : ibuprofen.
- Acetic acid : indomethacin.
- Oxicam : piroxicam.
- Anthranilic acid: meclophenamic acid.
As for COX-2 selective NSAIDs, we have: meloxicam, nimesulide, etodolac and coxibs such as celecoxib.
Pharmacokinetics of NSAIDs
These are rapidly absorbed drugs. The main route of administration is oral, but they also admit topical, intravenous and rectal ones. Once absorbed, they reach their maximum concentration in the blood after 2 – 3 hours. It is recommended to take NSAIDs with meals, as they can damage the intestinal mucosa.
These are drugs that in most cases bind in high percentages (about 95-99%) to albumin. Not a small detail, since due to the strong bond with albumin, different interactions can occur with other medicines that share the same characteristic.
They undergo hepatic metabolism and some possess active metabolites. In addition, almost all of them exhibit some degree of enterohepatic circulation. Once metabolized, they are excreted by the kidneys, therefore they should be taken with caution by patients with renal insufficiency, adjusting the dosage.
Adverse reactions of non-steroidal anti-inflammatory drugs
Taking any type of drug can lead to the development of side effects. It is important to know the risks and benefits of the drug well before taking.
Non-steroidal anti-inflammatories produce adverse gastrointestinal effects. This can cause difficulties in administering these pain relievers. But they are also nephrotoxic, meaning they can cause kidney problems. Among the most common adverse reactions we find:
- Hypertension.
- Heart problems.
- Skin rashes.
- Water retention.
Finally, before taking these medicines, always consider the option of consulting your doctor. Knowing the side effects and the correct application is the best way to get the maximum therapeutic benefit.
