nonsteroidal anti-inflammatory drug

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Nonsteroidal Anti-Inflammatory Drugs

Nonsteroidal Anti-Inflammatory Drugs

Definition

Nonsteroidal anti-inflammatory drugs are medicines that relieve pain, swelling, stiffness, and inflammation.

Purpose

Nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed for a variety of painful conditions, including arthritis, bursitis, tendinitis, gout, menstrual cramps, sprains, strains, and other injuries. They are also given to control the pain of cancer and the side effects of radiation therapy.

A group of researchers associated with the Women's Health Initiative reported in 2003 that regular use of aspirin, ibuprofen, and other NSAIDs may help to lower a woman's risk of developing breast cancer. Further clinical trials are needed, however, to confirm the group's findings.

Description

Nonsteroidal anti-inflammatory drugs relieve pain, stiffness, swelling, and inflammation, but they do not cure the diseases or injuries responsible for these problems. Two drugs in this category, ibuprofen and naproxen, also reduce fever. Some nonsteroidal anti-inflammatory drugs can be bought over the counter; others are available only with a prescription from a physician or dentist.

Among the drugs in this group are diclofenac (Voltaren), etodolac (Lodine), flurbiprofen (Ansaid), ibuprofen (Motrin, Advil, Rufen), ketorolac (Toradol), nabumetone (Relafen), naproxen (Naprosyn); naproxen sodium (Aleve, Anaprox, Naprelan); and oxaprozin (Daypro). They are sold as tablets, capsules, caplets, liquids, and rectal suppositories and some are available in chewable, extended-release, or delayed-release forms.

A newer group of NSAIDs known as COX-2 inhibitors are being used successfully to treat patients with allergic reactions to the older NSAIDs. Their name comes from the fact that they block an enzyme known as cyclooxygenase-2, or COX-2, which is involved in the inflammation pathway. The COX-2 inhibitors are also less likely to affect the patient's digestive tract. They include such drugs as celecoxib (Celebrex), rofecoxib (Vioxx), etoricoxib (Arcoxia), and valdecoxib (Bextra). With regard to cancer treatment, some studies indicate that the use of COX-2 inhibitors may postpone the need to prescribe narcotic medications for severe pain.

Recommended dosage

Recommended doses vary, depending on the patient, the type of nonsteroidal anti-inflammatory drug prescribed, the condition for which the drug is prescribed, and the form in which it is used. Always take nonsteroidal anti-inflammatory drugs exactly as directed. If using non-prescription (over-the-counter) types, follow the directions on the package label. For prescription types, check with the physician who prescribed the medicine or the pharmacist who filled the prescription. Never take larger or more frequent doses, and do not take the drug for longer than directed. Patients who take nonsteroidal anti-inflammatory drugs for severe arthritis must take them regularly over a long time. Several weeks may be needed to feel the results, so it is important to keep taking the medicine, even if it does not seem to be working at first.

When taking nonsteroidal anti-inflammatory drugs in tablet, capsule, or caplet form, always take them with a full, 8-ounce glass of water or milk. Taking these drugs with food or an antacid will help prevent stomach irritation.

Precautions

Nonsteroidal anti-inflammatory drugs can cause a number of side effects, some of which may be very serious (See Side effects). These side effects are more likely when the drugs are taken in large doses or for a long time or when two or more nonsteroidal anti-inflammatory drugs are taken together. Health care professionals can help patients weigh the risks of benefits of taking these medicines for long periods.

Do not take acetaminophen, aspirin, or other salicylates along with other nonsteroidal anti-inflammatory drugs for more than a few days unless directed to do so by a physician. Do not take ketorolac (Toradol) while taking other nonsteroidal anti-inflammatory drugs unless directed to do so by a physician.

Because older people are more sensitive than younger adults to nonsteroidal anti-inflammatory drugs, they may be more likely to have side effects. Some side effects, such as stomach problems, may also be more serious in older people.

Serious side effects are especially likely with one nonsteroidal anti-inflammatory drug, phenylbutazone. Patients age 40 and over are especially at risk of side effects from this drug, and the likelihood of serious side effects increases with age. Because of these potential problems, it is especially important to check with a physician before taking this medicine. Never take it for anything other than the condition for which it was prescribed, and never share itor any other prescription drugwith another person.

Some nonsteroidal anti-inflammatory drugs can increase the chance of bleeding after surgery (including dental surgery), so anyone who is taking the drugs should alert the physician or dentist before surgery. Avoiding the medicine or switching to another type in the days prior to surgery may be necessary.

Some people feel drowsy, dizzy, confused, light-headed, or less alert when using these drugs. Blurred vision or other vision problems also are possible side effects. For these reasons, anyone who takes these drugs should not drive, use machines or do anything else that might be dangerous until they have found out how the drugs affect them.

Nonsteroidal anti-inflammatory drugs make some people more sensitive to sunlight. Even brief exposure to sunlight can cause severe sunburn, rashes, redness, itching, blisters, or discoloration. Vision changes also may occur. To reduce the chance of these problems, avoid direct sunlight, especially from mid-morning to mid-afternoon; wear protective clothing, a hat, and sunglasses; and use a sunscreen with a skin protection factor (SPF) rating of at least 15. Do not use sunlamps, tanning booths or tanning beds while taking these drugs.

Special conditions

People with certain medical conditions and people who are taking some other medicines can have problems if they take nonsteroidal anti-inflammatory drugs. Before taking these drugs, be sure to let the physician know about any of these conditions:

ALLERGIES. Let the physician know about any allergies to foods, dyes, preservatives, or other substances. Anyone who has had reactions to nonsteroidal anti-inflammatory drugs in the past should also check with a physician before taking them again.

PREGNANCY. Women who are pregnant or who plan to become pregnant should check with their physicians before taking these medicines. Whether non-steroidal anti-inflammatory drugs cause birth defects in people is unknown, but some do cause birth defects in laboratory animals. If taken late in pregnancy, these drugs may prolong pregnancy, lengthen labor time, cause problems during delivery, or affect the heart or blood flow of the fetus.

BREASTFEEDING. Some nonsteroidal anti-inflammatory drugs pass into breast milk. Women who are breastfeeding should check with their physicians before taking these drugs.

OTHER MEDICAL CONDITIONS. A number of medical conditions may influence the effects of nonsteroidal anti-inflammatory drugs. Anyone who has any of the conditions listed below should tell his or her physician about the condition before taking nonsteroidal anti-inflammatory drugs.

  • stomach or intestinal problems, such as colitis or Crohn's disease
  • liver disease
  • current or past kidney disease ; current or past kidney stones
  • heart disease
  • high blood pressure
  • blood disorders, such as anemia, low platelet count, low white blood cell count
  • bleeding problems
  • diabetes mellitus
  • hemorrhoids, rectal bleeding, or rectal irritation
  • asthma
  • Parkinson's disease
  • epilepsy
  • systemic lupus erythematosus
  • diseases of the blood vessels, such as polymyalgia rheumatica and temporal arteritis
  • fluid retention
  • alcohol abuse
  • mental illness.

People who have sores or white spots in the mouth should tell the physician about them before starting to take nonsteroidal anti-inflammatory drugs. Sores or white spots that appear while taking the drug can be a sign of serious side effects.

SPECIAL DIETS. Some nonsteroidal anti-inflammatory drugs contain sugar or sodium, so anyone on a low-sugar or low-sodium diet should be sure to tell his or her physician.

SMOKING. People who smoke cigarettes may be more likely to have unwanted side effects from this medicine.

USE OF CERTAIN MEDICINES. Taking nonsteroidal anti-inflammatory drugs with certain other drugs may affect the way the drugs work or increase the risk of unwanted side effects. (See Interactions.)

Side effects

The most common side effects are stomach pain or cramps, nausea, vomiting, indigestion, diarrhea, heartburn, headache, dizziness or lightheadedness, and drowsiness. As the patient's body adjusts to the medicine, these symptoms usually disappear. If they do not, check with the physician who prescribed the medicine.

Serious side effects are rare, but do sometimes occur. If any of the following side effects occur, stop taking the medicine and get emergency medical care immediately:

  • swelling or puffiness of the face
  • swelling of the hands, feet, or lower legs
  • rapid weight gain
  • fainting
  • breathing problems
  • fast or irregular heartbeat
  • tightness in the chest

Other side effects do not require emergency medical care, but should have medical attention. If any of the following side effects occur, stop taking the medicine and call the physician who prescribed the medicine as soon as possible:

  • severe pain, cramps, or burning in the stomach or abdomen
  • convulsions
  • fever
  • severe nausea, heartburn, or indigestion
  • white spots or sores in the mouth or on the lips
  • rashes or red spots on the skin
  • any unusual bleeding, including nosebleeds, spitting up or vomiting blood or dark material
  • black, tarry stool
  • chest pain
  • unusual bruising
  • severe headaches

A number of less common, temporary side effects are also possible. They usually do not need medical attention and will disappear once the body adjusts to the medicine. If they continue or interfere with normal activity, check with the physician. Among these side effects are:

  • gas, bloating, or constipation
  • bitter taste or other taste changes
  • sweating
  • restlessness, irritability, anxiety
  • trembling or twitching

Some patients who have had problems with side effects from NSAIDs may benefit from acupuncture as an adjunctive treatment in pain management. A recent study done in New York found that older patients with lower back pain related to cancer reported that their pain was relieved by acupuncture with fewer side effects than those caused by NSAIDs.

Interactions

Nonsteroidal anti-inflammatory drugs may interact with a variety of other medicines. When this happens, the effects of the drugs may change, and the risk of side effects may be greater. Anyone who takes these drugs should let the physician know all other medicines he or she is taking. Among the drugs that may interact with nonsteroidal anti-inflammatory drugs are:

  • blood thinning drugs, such as warfarin (Coumadin)
  • other nonsteroidal anti-inflammatory drugs
  • heparin
  • tetracyclines
  • cyclosprorine
  • digitalis drugs
  • lithium
  • phenytoin (Dilantin)
  • zidovudine (AZT, Retrovir).

NSAIDs may also interact with certain herbal preparations sold as dietary supplements. Among the herbs known to interact with NSAIDs are bearberry (Arctostaphylos uva-ursi ), feverfew (Tanacetum parthenium ), evening primrose (Oenothera biennis ), and gossypol, a pigment obtained from cottonseed oil and used as a male contraceptive. In most cases, the herb increases the tendency of NSAIDs to irritate the digestive tract. It is just as important for patients to inform their doctor of herbal remedies that they take on a regular basis as it is to give the doctor a list of their other prescription medications.

KEY TERMS

Anemia A lack of hemoglobinthe compound in blood that carries oxygen from the lungs throughout the body and brings waste carbon dioxide from the cells to the lungs, where it is released.

Bursitis Inflammation of the tissue around a joint.

Colitis Inflammation of the colon (large bowel.

COX-2 inhibitors A class of newer NSAIDs that are less likely to cause side effects in the digestive tract. COX-2 inhibitors work by inhibiting the production of cyclooxygenase-2, an enzyme involved in inflammation.

Inflammation Pain, redness, swelling, and heat that usually develop in response to injury or illness.

Salicylates A group of drugs that includes aspirin and related compounds. Salicylates are used to relieve pain, reduce inflammation, and lower fever.

Tendinitis Inflammation of a tendon, which is a tough band of tissue that connects muscle to bone.

Resources

BOOKS

Beers, Mark H., MD, and Robert Berkow, MD., editors. "Drug Therapy in the Elderly." Section 22, Chapter 304 In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

Pelletier, Dr. Kenneth R. The Best Alternative Medicine, Part I: Western Herbal Medicine. New York: Simon and Schuster, 2002.

Wilson, Billie Ann, RN, PhD, Carolyn L. Stang, PharmD, and Margaret T. Shannon, RN, PhD. Nurses Drug Guide 2000. Stamford, CT: Appleton and Lange, 1999.

PERIODICALS

Birbara, C. A., A. D. Puopolo, D. R. Munoz, et al. "Treatment of Chronic Low Back Pain with Etoricoxib, A New Cyclo-Oxygenase-2 Selective Inhibitor: Improvement in Pain and DisabilityA Randomized, Placebo-Controlled, 3-Month Trial." Journal of Pain 4 (August 2003): 307-315.

Gordon, D. B. "Nonopioid and Adjuvant Analgesics in Chronic Pain Management: Strategies for Effective Use." Nursing Clinics of North America 38 (September 2003): 447-464.

Graf, C., and K. Puntillo. "Pain in the Older Adult in the Intensive Care Unit." Critical Care Clinics 19 (October 2003): 749-770.

Harris, R. E., R. T. Chlebowski, R. D. Jackson, et al. "Breast cancer and Nonsteroidal Anti-Inflammatory Drugs: Prospective Results from the Women's Health Initiative." Cancer Research 63 (September 15, 2003): 6096-6101.

Hatsiopoulou, O., R. I. Cohen, and E. V. Lang. "Postprocedure Pain Management of Interventional Radiology Patients." Journal of Vascular and Interventional Radiology 14 (November 2003): 1373-1385.

Meng, C. F., D. Wang, J. Ngeow, et al. "Acupuncture for Chronic Low Back Pain in Older Patients: A Randomized, Controlled Trial." Rheumatology (Oxford) 42 (December 2003): 1508-1517.

Perrone, M. R., M. C. Artesani, M. Viola, et al. "Tolerability of Rofecoxib in Patients with Adverse Reactions to Nonsteroidal Anti-Inflammatory Drugs: A Study of 216 Patients and Literature Review." International Archives of Allergy and Immunology 132 (September 2003): 82-86.

Raffa, R. B., R. Clark-Vetri, R. J. Tallarida, and A. I. Wertheimer. "Combination Strategies for Pain Management." Expert Opinion in Pharmacotherapy 4 (October 2003): 1697-1708.

Small, R. C., and A. Schuna. "Optimizing Outcomes in Rheumatoid Arthritis." Journal of the American Pharmaceutical Association 43, no. 5, Supplement 1 (September-October 2003): S16-S17.

Stephens, J., B. Laskin, C. Pashos, et al. "The Burden of Acute Postoperative Pain and the Potential Role of the COX-2-Specific Inhibitors." Rheumatology (Oxford) 42, Supplement 3 (November 2003): iii40-iii52.

ORGANIZATIONS

U. S. Food and Drug Administration (FDA). 5600 Fishers Lane, Rockville, MD 20857. (888) 463-6332. http://www.fda.gov.

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Ross-Flanigan, Nancy; Frey, Rebecca. "Nonsteroidal Anti-Inflammatory Drugs." Gale Encyclopedia of Medicine, 3rd ed.. 2006. Encyclopedia.com. 23 Jul. 2016 <http://www.encyclopedia.com>.

Ross-Flanigan, Nancy; Frey, Rebecca. "Nonsteroidal Anti-Inflammatory Drugs." Gale Encyclopedia of Medicine, 3rd ed.. 2006. Encyclopedia.com. (July 23, 2016). http://www.encyclopedia.com/doc/1G2-3451601143.html

Ross-Flanigan, Nancy; Frey, Rebecca. "Nonsteroidal Anti-Inflammatory Drugs." Gale Encyclopedia of Medicine, 3rd ed.. 2006. Retrieved July 23, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3451601143.html

Nonsteroidal Anti-Inflammatory Drugs

Nonsteroidal anti-inflammatory drugs

Definition

Nonsteroidal anti-inflammatory drugs are medicines that relieve pain , swelling, stiffness, and inflammation.

Description

Nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed for a variety of painful conditions, including arthritis, bursitis, tendonitis, gout, menstrual cramps, sprains , strains , and other injuries.

Although the NSAIDs are often discussed as a group, not all are approved for use in children. As of 2004, the following drugs are approved for pediatric use:

  • Ibuprofen (Advil, Motrin, Nuprin).
  • Indomethicin (Indocin), not recommended for children under the age of 14 except in circumstances that warrant the risk. Indomethicin has special application in some infants born with heart problems.
  • Ketoprofen (Orudis, Oruvail), not given to children under the age of 16 unless directed by a physician.
  • Ketorolac tromethamine (Toradol), not approved for use in children but has been reported safe by some pediatric authorities.
  • Meclofenamate sodium, safety and efficacy in children under 14 years of age has not been established.
  • Mefenamic acid (Ponstel), safety and efficacy in children under 14 years of age has not been established.
  • Naproxen (Aleve, Anaprox, Naprosyn), safety and efficacy in children under two years of age has not been established.
  • Tolmetin sodium (Tolectin), safety and efficacy in children under two years of age has not been established.

Other NSAIDs have been used in pediatric therapy, but should not be considered as first choice for treatment of children or adolescents.

A new class of NSAIDs, called COX-2 inhibitors, have a lower risk of causing ulcers than do the traditional NSAIDs. These drugs may be appropriate for use in older teenagers but have not been approved for use in younger children, and there is some evidence that they are inappropriate for infants.

General use

Nonsteroidal anti-inflammatory drugs relieve pain, stiffness, swelling, and inflammation, but they do not cure the diseases or injuries responsible for these problems. Two drugs in this category, ibuprofen and naproxen, also reduce fever . Some nonsteroidal anti-inflammatory drugs can be bought without a prescription; others are available only with a prescription from a physician or dentist.

Precautions

Children with certain medical conditions and those who are taking some other medicines can have problems if they take nonsteroidal anti-inflammatory drugs. Before giving children these drugs, parents need to let the physician know about any of the following conditions.

Allergies

The physician needs to know about any allergies to foods, dyes, preservatives, or other substances. For children who have had reactions to nonsteroidal anti-inflammatory drugs in the past, parents should check with a physician before having these drugs prescribed again.

Pregnancy

Teens and young women who are pregnant or who plan to become pregnant should check with their physicians before taking these medicines. Whether nonsteroidal anti-inflammatory drugs cause birth defects in people is unknown, but some do cause birth defects in laboratory animals. If taken late in pregnancy, these drugs may prolong pregnancy, lengthen labor time, cause problems during delivery, or affect the heart or blood flow of the fetus.

Breastfeeding

Some nonsteroidal anti-inflammatory drugs pass into breast milk. Women who are breastfeeding their babies should check with their physicians before taking these drugs.

Other medical conditions

A number of medical conditions may influence the effects of nonsteroidal anti-inflammatory drugs. Parents of children and teens who have any of the conditions listed below should tell their physician about the condition before having nonsteroidal anti-inflammatory drugs prescribed.

  • stomach or intestinal problems, such as colitis or Crohn's disease
  • liver disease
  • current or past kidney disease or current or past kidney stones
  • heart disease
  • high blood pressure
  • blood disorders, such as anemia, low platelet count , low white blood cell count
  • bleeding problems
  • diabetes mellitus
  • hemorrhoids, rectal bleeding, or rectal irritation
  • asthma
  • epilepsy
  • systemic lupus erythematosus
  • diseases of the blood vessels, such as polymyalgia rheumatica and temporal arteritis
  • fluid retention
  • alcohol abuse
  • mental illness

Side effects

The most common side effects are stomach pain or cramps, nausea , vomiting , indigestion, diarrhea , heartburn, headache , dizziness or lightheadedness, and drowsiness. As the patient's body adjusts to the medicine, these symptoms usually disappear. If they do not, the physician who prescribed the medicine should be contacted.

Serious side effects are rare, but do sometimes occur. If any of the following side effects occur, patients should stop taking the medicine and get emergency medical care immediately:

  • swelling or puffiness of the face
  • swelling of the hands, feet, or lower legs
  • rapid weight gain
  • fainting
  • breathing problems
  • fast or irregular heartbeat
  • tightness in the chest

Other side effects do not require emergency medical care, but should have medical attention. If any of the following side effects occur, patients should stop taking the medicine and the physician who prescribed the medicine should be called as soon as possible:

  • severe pain, cramps, or burning in the stomach or abdomen
  • convulsions
  • fever
  • severe nausea, heartburn, or indigestion
  • white spots or sores in the mouth or on the lips
  • rashes or red spots on the skin
  • any unusual bleeding, including nosebleeds and spitting up or vomiting blood or dark material
  • black, tarry stool
  • chest pain
  • unusual bruising
  • severe headaches

A number of less common, temporary side effects are also possible. They usually do not need medical attention and will disappear once the body adjusts to the medicine. If they continue or interfere with normal activity, the physician should be contacted. Among these side effects are:

  • gas, bloating, or constipation
  • bitter taste or other taste changes
  • sweating
  • restlessness, irritability, anxiety
  • trembling or twitching

Interactions

Nonsteroidal anti-inflammatory drugs may interact with a variety of other medicines. When interaction occurs, the effects of the drugs may change, and the risk of side effects may be greater. Physicians prescribing this drug should know all other medicines the patient is already taking. Among the drugs that may interact with nonsteroidal anti-inflammatory drugs are:

  • blood thinning drugs, such as warfarin (Coumadin)
  • other nonsteroidal anti-inflammatory drugs
  • heparin
  • tetracyclines
  • cyclosprorine
  • digitalis drugs
  • lithium
  • phenytoin (Dilantin)
  • zidovudine (AZT, Retrovir)

NSAIDs may also interact with certain herbal preparations sold as dietary supplements. Among the herbs known to interact with NSAIDs are bearberry (Arctostaphylos uva-ursi ), feverfew (Tanacetum parthenium ), evening primrose (Oenothera biennis ), and gossypol, a pigment obtained from cottonseed oil and used as a male contraceptive. In most cases, the herb increases the tendency of NSAIDs to irritate the digestive tract. It is just as important for doctors to know which herbal remedies the patient is taking on a regular basis as it is for doctors to know the other prescription medications which are being taken.

Prevention

Many serious digestive system effects of NSAIDs can be prevented by taking mysoprostol (Cytotec), but this drug is only appropriate for patients with a high risk of ulcers. It is not called for when the NSAID is being used for a short period of time or in patients with other risk factors. Stomach upset can often be prevented by taking NSAIDs with food or milk.

Parental concerns

NSAIDs are very safe when used properly over a short period of time. They should not be used for longer periods or in larger doses than indicated on the label. If NSAIDs are to be used for prolonged periods, as in juvenile rheumatoid arthritis, there is a risk of potentially serious stomach and intestinal problems.

KEY TERMS

Anemia A lack of hemoglobin, the compound in blood that carries oxygen from the lungs throughout the body and brings waste carbon dioxide from the cells to the lungs, where it is released.

Bursitis Inflammation of the tissue around a joint.

Colitis Inflammation of the colon (large bowel).

COX-2 inhibitors A class of newer NSAIDs that are less likely to cause side effects in the digestive tract. COX-2 inhibitors work by inhibiting the production of cyclooxygenase-2, an enzyme involved in inflammation.

Inflammation Pain, redness, swelling, and heat that usually develop in response to injury or illness.

Salicylates A group of drugs that includes aspirin and related compounds. Salicylates are used to relieve pain, reduce inflammation, and lower fever.

Tendonitis Inflammation of a tendon, which is a tough band of tissue that connects muscle to bone.

Resources

BOOKS

Pelletier, Kenneth R. The Best Alternative Medicine, Part I: Western Herbal Medicine. New York: Simon and Schuster, 2002.

PERIODICALS

Gordon, D. B. "Nonopioid and Adjuvant Analgesics in Chronic Pain Management: Strategies for Effective Use." Nursing Clinics of North America 38 (September 2003): 447464.

Small, R. C., and A. Schuna. "Optimizing Outcomes in Rheumatoid Arthritis." Journal of the American Pharmaceutical Association 43, no. 5, suppl. 1 (September-October 2003): S16S17.

Stempak, D., et al. "Single-dose and steady-state pharmacokinetics of celecoxib in children." Clinical Pharmacological Therapy 72, no. 5 (November 2002): 490497.

ORGANIZATIONS

U. S. Food and Drug Administration (FDA). 5600 Fishers Lane, Rockville, MD 20857. Web site: <http://www.fda.gov>.

WEB SITES

Pediatric Rheumatology Online Journal. Available online at <www.pedrheumonlinejournal.org/> (accessed on September 29, 2004).

Nancy Ross-Flanigan Rebecca J. Frey, PhD Samuel Uretsky, PharmD

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Ross-Flanigan, Nancy; Frey, Rebecca; Uretsky, Samuel. "Nonsteroidal Anti-Inflammatory Drugs." Gale Encyclopedia of Children's Health: Infancy through Adolescence. 2006. Encyclopedia.com. 23 Jul. 2016 <http://www.encyclopedia.com>.

Ross-Flanigan, Nancy; Frey, Rebecca; Uretsky, Samuel. "Nonsteroidal Anti-Inflammatory Drugs." Gale Encyclopedia of Children's Health: Infancy through Adolescence. 2006. Encyclopedia.com. (July 23, 2016). http://www.encyclopedia.com/doc/1G2-3447200404.html

Ross-Flanigan, Nancy; Frey, Rebecca; Uretsky, Samuel. "Nonsteroidal Anti-Inflammatory Drugs." Gale Encyclopedia of Children's Health: Infancy through Adolescence. 2006. Retrieved July 23, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3447200404.html

Nonsteroidal Anti-Inflammatory Drugs

Nonsteroidal anti-inflammatory drugs

Definition

Nonsteroidal anti-inflammatory drugs (NSAIDs) are medications other than corticosteroids that relieve pain, swelling, stiffness, and inflammation.


Purpose

Nonsteroidal anti-inflammatory drugs are prescribed for a variety of painful conditions, including arthritis, bursitis, tendinitis, gout, menstrual cramps, sprains, strains, and other injuries. They may be used for treatment of post-surgical pain that either is too mild to require narcotic analgesics or follows a period of use of stronger analgesics. Ketorolac (Toradol) may be used in place of narcotics for treatment of acute pain in patients who should not receive narcotics.


Description

The nonsteroidal anti-inflammatory drugs are a group of agents that inhibit prostaglandin synthetase, thereby reducing the process of inflammation. As a group, they are all effective analgesics. Some, including the salicylates, ibuprofen, and naproxene, are also useful antipyretics (fever-reducers).

Although NSAIDs fall into discrete chemical classes, they are usually divided into the nonselective NSAIDs and the COX-2 specific agents. Among the nonspecific NSAIDs are diclofenac (Voltaren), etodolac (Lodine), flurbiprofen (Ansaid), ibuprofen (Motrin, Advil, Rufen), ketorolac (Toradol), nabumetone (Relafen), naproxen (Naprosyn), naproxen sodium (Aleve, Anaprox, Naprelan), and oxaprozin (Daypro). The COX-2 specific drugs are celecoxib (Celebrex) and rofecoxib (Vioxx).

Nonselective NSAIDS inhibit both cyclooxygenase 1 and cyclooxygenase 2 (COX-2). Cyclooxygenase 1 is important for homeostatic maintenance such as platelet aggregation, the regulation of blood flow in the kidney and stomach, and the regulation of gastric acid secretion. The inhibition of cyclooxygenase 1 is considered the primary cause of NSAID toxicity, including gastric ulceration and bleeding disorders. COX-2 is the primary cause of pain and inflammation. Both celecoxib and rofecoxib are relatively selective, and may cause the same adverse effects as the nonselective drugs, although with somewhat reduced frequency.

The analgesic activity of NSAIDs has not been fully explained. Antipyretic activity may be caused by the inhibition of prostaglandin E2 (PGE2) synthesis.

Although not all NSAIDs have approved indications for all uses, as a class, they are used for:

  • ankylosing spondylitis
  • bursitis
  • fever
  • gout
  • headache
  • juvenile arthritis
  • mild to moderate pain
  • osteoarthritis
  • PMS
  • primary dysmennorhea
  • rheumatoid arthritis
  • tendinitis

Recommended dosage

Recommended doses vary, depending on the patient, the type of nonsteroidal anti-inflammatory drug prescribed, the condition for which the drug is prescribed, and the form in which it is used. The patient is advised to consult specific sources for detailed information or ask a physician.


Precautions

The most common hazard associated with NSAID use is gastrointestinal intolerance and ulceration. This may occur without warning and is a greater risk among patients over the age of 65. The risk appears to rise with increasing length of treatment and increasing dose. Patients should be aware of the warning signs of gastrointestinal (GI) bleeding.

Allergic reactions are rare, but may be severe. Patients who have allergic reactions to aspirin should not be treated with NSAIDs.

Because NSAID metabolites are eliminated by the kidney, renal toxicity should be considered. Clinicians should monitor kidney function before and during NSAID use.

Among the NSAIDs that are classed as pregnancy category B are ketoprofen, naproxen, naproxen sodium, flurbiprofen, and diclofenac. Etodolac, ketorolac, mefenamic acid, meloxicam, nabumetone, oxaprozin, tolmetin, piroxicam, rofecoxib, and celecoxib are category C. Breastfeeding is not advised while taking NSAIDs.

Many other rare but potentially serious adverse effects have been reported with NSAIDs. The consumer should consult specific references.


Interactions

Many drug interactions have been reported with NSAID therapy. The most serious are those that may affect the bleeding hazards associated with NSAIDs. Consumers are advised to consult specific references for further information. A partial list of interacting drugs follows:

  • blood thinning drugs, such as warfarin (Coumadin)
  • other nonsteroidal anti-inflammatory drugs
  • heparin
  • tetracyclines
  • cyclosprorine
  • digitalis drugs
  • lithium
  • phenytoin (Dilantin)
  • zidovudine (AZT, Retrovir)

Resources

books

AHFS: Drug Information. Washington, DC: Amer Soc Health-systems Pharm, 2002.

Brody, T., J. Larner, K. P. Minneman, and H. C. Neu. Human Pharmacology Molecular to Clinical. 2nd edition. St Louis: Mosby Year-Book,1995.

Karch, A. M. Lippincott's Nursing Drug Guide. Springhouse, PA: Lippincott Williams & Wilkins, 2003.

Reynolds, J. E. F., ed. Martindale, The Extra Pharmacopoeia. 31st Edition. London: The Pharmaceutical Press, 1996.


Samuel D. Uretsky, PharmD

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Uretsky, Samuel D.. "Nonsteroidal Anti-Inflammatory Drugs." Gale Encyclopedia of Surgery: A Guide for Patients and Caregivers. 2004. Encyclopedia.com. 23 Jul. 2016 <http://www.encyclopedia.com>.

Uretsky, Samuel D.. "Nonsteroidal Anti-Inflammatory Drugs." Gale Encyclopedia of Surgery: A Guide for Patients and Caregivers. 2004. Encyclopedia.com. (July 23, 2016). http://www.encyclopedia.com/doc/1G2-3406200315.html

Uretsky, Samuel D.. "Nonsteroidal Anti-Inflammatory Drugs." Gale Encyclopedia of Surgery: A Guide for Patients and Caregivers. 2004. Retrieved July 23, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3406200315.html

Nonsteroidal Anti-Inflammatory Drugs

Nonsteroidal anti-inflammatory drugs

Definition

Nonsteroidal antiinflammatory drugs (NSAIDs) reduce pain and inflammation.

Purpose

NSAIDs often are used to relieve mild to moderate pain for all types of cancer.

Description

This class of drugs eases discomfort by blocking the pathway of an enzyme that creates prostaglandins (hormones that cause pain and swelling). By doing so, the drugs lessen the pain in different parts of the body.

Some of the NSAIDs used in cancer treatment include: ibuprofen (Motrin, Advil, Rufen, Nuprin), naproxen (Naprosyn, Naprelan, Anaprox, Aleve), nabumetone (Relafen), ketorolac, sulindac and diclofenac (Cataflam, Voltaren). The class of drugs known as Cyclooxygenase-2 inhibitors that emerged in the late 1990s for dealing with arthritis pain, such as the brand names Celebrex and Vioxx, is also considered part of the group of NSAIDS.

If NSAIDs are not strong enough to keep a cancer patient comfortable, physicians often will combine them with opioids , such as codeine. In later stages, doctors also may combine NSAIDs with stronger pain killers, such as morphine, to treat very severe pain.

NSAIDs also may be used to prevent colon cancer and other types of cancer, although scientists are still studying this experimental approach (see entry on chemoprevention ).

Recommended dosage

Patients typically take NSAIDs on an as-needed basis. Doses vary depending on the type of NSAID being used. For example, the most common type, ibuprofen, is available over the counter in 200mg caplets, which can be taken at regular intervals throughout the day. The maximum daily dose for ibuprofen is 1, 200 mgs.

Precautions

Most doctors recommend taking NSAIDs with a full glass of water. Avoid taking these drugs on an empty stomach. Smoking cigarettes and drinking alcohol while taking NSAIDs may irritate the stomach.

People who take NSAIDs should notify their doctor before having surgery or dental work, since these drugs can prevent wounds from healing properly.

Women who are pregnant or breastfeeding should check with their doctor before taking NSAIDs, because they may be harmful to a developing fetus or a newborn.

Diabetics, people who take aspirin, blood thinners, blood pressure medications or steroids also should check with their doctor before taking NSAIDs.

Side effects

Many NSAID users experience mild side effects, such as an upset stomach. In 4 to 7% of cases, more serious complications develop, such as stomach ulcers. Typically, elderly people experience the most serious complications.

Common side effects include stomach upset, constipation, dizziness and headaches.

More severe side effects include stomach ulcers and bleeding ulcers. If a person has black, tarry stools or starts vomiting blood, it may be caused by a bleeding ulcer.

Kidney dysfunction is another severe complication of long-term NSAID use. Signs of kidney problems include dark yellow, brown or bloody urine. NSAID use also may cause liver function problems over longer periods of time.

To guard against ulcers, physicians may ask patients to take NSAIDs with anti-ulcer medication, such as omeprazole or misoprostol. Another option is to take the NSAID in a different, non-oral form. Often topical creams or suppositories are available. Finally, doctors may decide to switch to a different pain killer, such as a Cyclooxygenase-2 inhibitor like Celebrex, or codeine, which would be easier on the stomach.

Interactions

NSAIDs can be taken with most other prescription and over-the-counter drugs without any harmful interactions. Certain drug combinations, however, should be avoided. For instance, when ibuprofen is combined with methotrexate (used for chemotherapy and arthritis treatment) or certain diabetic medicines and anti-depressants, it can amplify negative side-effects. Patients should check with a pharmacist before taking NSAIDs with other drugs.

Melissa Knopper, M.S.

KEY TERMS

COX-2 inhibitor

Cyclooxygenase-2 inhibitor; A type of drug, such as Celebrex, that reduces pain and inflammation.

Enzyme

A protein that speeds the chemical reactions in the body.

NSAIDs

Nonsteroidal antiinflammatory drugs (NSAIDs) reduce pain, fever and swelling.

Opioids

A class of pain-killing drugs, including codeine.

Prostaglandins

Hormones that cause pain and swelling in the body.

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Knopper, Melissa. "Nonsteroidal Anti-Inflammatory Drugs." Gale Encyclopedia of Cancer. 2002. Encyclopedia.com. 23 Jul. 2016 <http://www.encyclopedia.com>.

Knopper, Melissa. "Nonsteroidal Anti-Inflammatory Drugs." Gale Encyclopedia of Cancer. 2002. Encyclopedia.com. (July 23, 2016). http://www.encyclopedia.com/doc/1G2-3405200335.html

Knopper, Melissa. "Nonsteroidal Anti-Inflammatory Drugs." Gale Encyclopedia of Cancer. 2002. Retrieved July 23, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3405200335.html

nonsteroidal anti-inflammatory drug

nonsteroidal anti-inflammatory drug, a drug that suppresses inflammation in a manner similar to steroids, but without the side effects of steroids; commonly referred to by the acronym NSAID (ĕn´sĕd). Also effective in alleviating pain and fever, NSAIDs are commonly used to treat the symptoms of arthritis, gout, bursitis, painful menstruation, and headache. They act by inhibiting the synthesis of prostaglandins, leukotrienes, and other compounds that are involved in the inflammatory process.

Aspirin is technically an NSAID, but the term is often used to refer to nonaspirin products. The first nonaspirin NSAIDs were introduced in 1964. Common NSAID products include diclofenac (Cataflam, Voltaren), indomethacin (Indocin), ketorolac (Acular, Toradol), and piroxicam (Feldene). Ibuprofen, naproxen, and ketoprofen are available as over-the-counter drugs in the United States. The cox-2 inhibitors, such as celecoxib (Celebrex), selectively inhibit clooxygenase-2 (cox-2), an enzyme that causes pain and inflammation in arthritic joints, but do not interfere with cox-1, which protects the stomach and intestinal lining from ulceration. Very common drugs, NSAIDs are taken daily by an estimated 3 million Americans.

Although they are often considered easier to tolerate than aspirin, and most do not have as strong an anticlotting effect as aspirin, NSAIDS can have serious side effects, particularly gastrointestinal ulcers and upper gastrointestinal tract bleeding and perforation in those who take the drugs on a regular basis. NSAID-related gastropathy results in more than 2,000 deaths in the United States each year.

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"nonsteroidal anti-inflammatory drug." The Columbia Encyclopedia, 6th ed.. 2016. Encyclopedia.com. 23 Jul. 2016 <http://www.encyclopedia.com>.

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"nonsteroidal anti-inflammatory drug." The Columbia Encyclopedia, 6th ed.. 2016. Retrieved July 23, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1E1-nonster.html

NSAID

NSAID (nonsteroidal anti-inflammatory drug) n. any one of a large group of drugs used for pain relief, particularly in rheumatic disease associated with inflammation. NSAIDs act by inhibiting the enzymes controlling the formation of prostaglandins, which are important mediators of inflammation. They include aspirin, diflunisal, ibuprofen, ketoprofen, and naproxen. Adverse effects include gastric bleeding and ulceration. See also COX-2 inhibitor.

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"NSAID." A Dictionary of Nursing. 2008. Encyclopedia.com. 23 Jul. 2016 <http://www.encyclopedia.com>.

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"NSAID." A Dictionary of Nursing. 2008. Retrieved July 23, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O62-NSAID.html

nonsteroidal anti-inflammatory drug

nonsteroidal anti-inflammatory drug (non-steer-oi-d'l) n. see NSAID.

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NSAID

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NSAID

NSAID Med. nonsteroidal anti-inflammatory drug

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FRAN ALEXANDER , PETER BLAIR , JOHN DAINTITH , ALICE GRANDISON , VALERIE ILLINGWORTH , ELIZABETH MARTIN , ANNE STIBBS , JUDY PEARSALL , and SARA TULLOCH. "NSAID." The Oxford Dictionary of Abbreviations. 1998. Encyclopedia.com. 23 Jul. 2016 <http://www.encyclopedia.com>.

FRAN ALEXANDER , PETER BLAIR , JOHN DAINTITH , ALICE GRANDISON , VALERIE ILLINGWORTH , ELIZABETH MARTIN , ANNE STIBBS , JUDY PEARSALL , and SARA TULLOCH. "NSAID." The Oxford Dictionary of Abbreviations. 1998. Encyclopedia.com. (July 23, 2016). http://www.encyclopedia.com/doc/1O25-NSAID.html

FRAN ALEXANDER , PETER BLAIR , JOHN DAINTITH , ALICE GRANDISON , VALERIE ILLINGWORTH , ELIZABETH MARTIN , ANNE STIBBS , JUDY PEARSALL , and SARA TULLOCH. "NSAID." The Oxford Dictionary of Abbreviations. 1998. Retrieved July 23, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1O25-NSAID.html

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