What are Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)?
NSAIDs include aspirin and drugs that inhibit the formation of cyclooxygenase (COX), are a class of drug that mitigates pain, decreases fever, and reduces inflammation.
 
Clinical application:
  1. Relieves musculoskeletal pain and reduces inflammation. They are some of the most commonly used medications in rheumatoid arthritis and ankylosing spondylitis.
  2. Reduces uterine contractions and relieves dysmenorrhea (some NSAIDs).
  3. Reduces fever.
  4. Inhibits platelet agglutination and prevents blood clot formation.
 
NSAIDs can be classified by the duration of action of the drug:
  1. Short-acting
    1. Acetaminophen paracetamol
    2. Indomethacin
    3. Ibuprofen
    4. Ketoprofen
    5. Tiaprofenic acid
    6. Diclofenac potassium
    7. Mefenamic acid
  2. Intermediate-acting
    1. Fenbufen
    2. Naproxen
    3. Sulidac
  3. Long-acting
    1. Piroxicam
    2. Acetylsalicylic acid
The selection and use of drug types should follow the instructions of the physician.
 
Adverse effects:
Using NSAIDs can cause side effects, but not with all the patients. Gastrointestinal (GI) symptoms are the most common side effects of NSAIDs, including dyspepsia, gastric or duodenal ulcers accompanied by bleeding or perforation, stenosis, obstruction, ulcerative oral mucositis or colitis. The incidence is around 10 to 20%. Renal insufficiency, abnormal liver function, dizziness, headache, lethargy, congestive heart failure, hypertension, photosensitivity, allergies and other side effects occasionally occur, but the incidence is low.
 
Who are at high risk for NSAIDs-related GI complications?
  1. Patients who are over 65 years of age.
  2. Patients with a past history of gastrointestinal ulcers.
  3. Patients who are using high-dose analgesics or combination of two or more analgesics.
  4. Patients who are using combination of various corticosteroid drugs.
 
Instructions for taking medications:
  1. NSAIDs should be taken with food, milk, or antacids to minimize gastrointestinal side effects. If symptoms continue or worsen, please contact your doctor.
  2. If there is a rash, itching, visual impairment, decreased urine, weight gain, edema, tarry stool or persistent headache, stop using NSAIDs and seek medical attention immediately.
  3. NSAIDs may cause drowsiness, dizziness or blurred vision, therefore, you should pay more attention while driving or doing tasks that require concentration. 
  4. Avoid the use of alcohol when taking NSAIDs.
  5. Do not take more than two non-NSAIDs at the same time because of the increased risk of side effects.
  6. After taking 1 or 2 doses of NSAIDs, if symptoms do not improve or side effects occur, stop using the drug immediately and seek medical advice. Do not exceed the recommended dose (especially acetaminophen).
  7. NSAIDs are useful in treating arthritis and controlling pain, do not stop using the drug abruptly. If side effects occur, seek medical treatment immediately.
  8. Long-term use of NSAIDs needs to be assessed by a physician. 
  9. If there is a history of drug allergies, consult a pharmacist and physician before taking NSAIDs.
 
Reference
  1. Akgul, O., Mannelli, L. D. C., Vullo, D., Angeli, A., Ghelardini, C., Bartolucci, G., … Carta, F. (2018). Discovery of novel nonsteroidal anti-Inflammatory drugs and carbonic anhydrase inhibitors hybrids (NSAIDs–CAIs) for the management of rheumatoid arthritis. Journal of Medicinal Chemistry, 61(11), 4961-4977. https://doi.org/10.1021/acs.jmedchem.8b00420
  2. Dai, H. W., Chang, C. W., Chen, M. J., Lin, W. C., & Chu, C. H`. (2019). Non-steroidal anti-inflammatory drug-induced enteropathy in the elderly. International Journal of Gerontology, 13(2), 181-182. https://doi.org/10.6890/IJGE.201906_13(2).0017
  3. Hua, X., Phipps, A. I., Burnett-Hartman, A. N., Adams, S. V., Hardikar, S., Cohen, S. A., ... Newcomb, P. A. (2017). Timing of aspirin and other nonsteroidal anti-inflammatory drug use among patients with colorectal cancer in relation to tumor markers and survival. Journal of Clinical Oncology, 35(24), 2806-2813. https://doi.org/10.1200/jco.2017.72.3569
  4. Pok, L. S. L., Shabaruddin, F. H., Dahlui, M., Sockalingam, S., Said, M., Shahrir, M., ... Hussein, H.(2018). Clinical and economic implications of upper gastrointestinal adverse events in Asian rheumatological patients on long‐term non‐steroidal anti‐inflammatory drugs. International Journal of Rheumatic Diseases. https://doi.org/10.1111/1756-185X.13256
  5. Tai, F. W. D., & McAlindon, M. E. (2018). NSAIDs and the small bowel. Current Opinion in Gastroenterology, 34(3), 175-182. https://doi.org/10.1097/MOG.0000000000000427
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