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

Last updated on November 27, 2019 at 13:42

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

NSAIDSpecial featuresSpecial indications
NaproxenLess cardiovascular risk, strong plasma protein binding
IbuprofenLess GI, renal, cardiovascular (?) side effect risk, strong plasma protein binding
DiclofenacAccumulates in synovial fluid, higher cardiovascular riskRheumatoid arthritis
IndomethacinInhibits phagocytosis of urate crystalsGout
COX2-preferential and COX2-specific NSAIDs

Compounds:

  • COX2-preferential
    • Celexocib
    • Paracetamol
    • Meloxicam
  • COX2-specific
    • Parecoxib
    • Etoricoxib

These drugs have an important benefit over traditional NSAIDs; they cause minimal gastrointestinal side effects.

Dosing:

All orally, except parecoxib which is IV.

Indications:

  • Same as for non-selective NSAIDs, but preferred in people with:
    • Peptic ulcer
    • Platelet disorders
    • Aspirin asthma
  • Unique indications
    • Prevention of colorectal cancer in famillial adenomatous polyposis

Contraindications:

  • Sulpha drug allergy

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

Side effects:

  • No antiplatelet effect
  • Minimal GI side effects
  • No aspirin asthma
  • Same as for non-selective NSAIDs:
    • Decreased renal function
    • Cardiovascular side effects

It was previously believed that COX2-selective NSAIDs produced more cardiovascular side effects than the non-selective ones, but recently that has been disproved. Both types cause similar risk for cardiovascular side effects.


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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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