29. Non-steroidal antiinflammatory drugs. Drugs other than aspirin or paracetamol

Last updated on June 21, 2019 at 11:52

The analgetic and antiinflammatory effects of different NSAIDs are very similar. Some patients respond better to some NSAIDs than others.

Naproxen and ibuprofen

Naproxen causes less cardiovascular risk than other NSAIDs. Ibuprofen has fewer GI side effects than other non-selective NSAIDs.

Indications:

Pain, fever, rheumatoid arthritis.

Mechanism of action:

Non-selective COX inhibition.

Pharmacokinetics:

These drugs have 99% plasma protein binding.

Interactions:

These drugs interact with other drugs that have strong plasma protein binding.

Side effects:

Same as for other NSAIDs, but these drugs cause fewer GI side effects.

Diclofenac

Indications:

Pain, fever, rheumatoid arthritis.

Mechanism of action:

Non-selective COX inhibitor. Accumulates in synovial fluid, making it especially effective for rheumatoid arthritis.

Side effects:

Same as for other NSAIDs. Has higher risk for cardiovascular side effects than other NSAIDs.

Indomethacin

Indications:

Pain, fever, gout.

Mechanism of action:

Non-selective COX inhibition. Inhibits phagocytosis of urate crystals.

Coxibs

The important coxibs are celecoxib, parecoxib and etoricoxib. Celecoxib is COX2-preferential while the others are COX2-selective NSAIDs. These drugs have an important benefit over traditional NSAIDs; they cause minimal gastrointestinal side effects.

Dosing:

All coxibs are given orally, except parecoxib which is IV.

Indications:

Same as for traditional NSAIDs, but especially preferred in people with peptic ulcer disease or other gastrointestinal disease. They’re also safe in people with “aspirin asthma”.

COX2 is also found in precancerous lesions in the GI tract. These drugs inhibit this and may prevent cancer development. This is especially important to postpone CRC in familial adenomatous polyposis.

Mechanism of action:

Etoricoxib and parecoxib are COX2-selective NSAIDs. Celecoxib is COX2-preferential.

Contraindications:

These drugs are sulpha drugs, so they should be used carefully in people with allergy to sulphonamide antibiotics.

Side effects:

Minimal gastrointestinal side effects. Similar renal side effects and increased risk for arterial thrombosis as with traditional NSAIDs.


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28. Non-steroidal antiinflammatory drugs. Aspirin, paracetamol

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30. Adjuvant analgesics. Drugs used to treat gout. Centrally-acting muscle relaxants

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