Nonsteroidal Anti-Inflammatory Drugs

By

M.H.Farjoo M.D. , Ph.D.Shahid Beheshti University of Medical Science

Nonsteroidal Anti-Inflammatory Drugs

Introduction & Classification Mechanism of Action Adverse Effects Acetylsalicylic acid (ASA) Acetaminophen Other Non-Selective COX Inhibitors COX-2 Selective Inhibitors Drug Pictures

Introduction & Classification

NSAIDs: nonsteroidal anti-inflammatory drugs

The cyclooxygenase pathway of arachidonate metabolism produces prostaglandins

COX-1 isoform tends to be homeostatic in function

COX-2 is induced during inflammation Highly selective COX-2 inhibitors have been

developed

Acetylsalicylic acid (ASA) Aspirin inhibits both COX isozymes Analgesic effects Antipyretic effects Antiplatelet effects Clinical uses

Mild to moderate pain Transient ischemic attacks Unstable angina Coronary artery thrombosis

Contraindication: Patients with hemophilia

Toxicity

Irreversible inhibition of platelet COXAntiplatelet effect lasts 8–10 days (the life of the platelet)

Acetaminophen Treatment of mild to moderate pain No significant antiinflammatory effects Equivalent to aspirin as an analgesic and antipyretic

agent Lacks anti-inflammatory and platelet-inhibiting

properties Is the preferred drug in patients allergic to aspirin Is preferable to aspirin in patients with hemophilia or

a history of peptic ulcer Preferred to aspirin in children with viral infections

Other Non-Selective COX Inhibitors

Ibuprofen With aspirin may decrease the total anti-inflammatory

effect Antagonizes the irreversible platelet inhibition

induced by aspirin

Mefenamic acid Should not be used for longer than 1 week Should not be given to children

Other Non-Selective COX Inhibitors

Indomethacin Gout Ankylosing spondylitis Patent ductus arteriosus (PDA) Has the greatest toxicity among NSAIDs Is slightly selective for COX-1

COX-2 Selective Inhibitors

Celecoxib and rofecoxib preferentially inhibit COX-2

Fewer gastrointestinal side effects

No impact on platelet aggregation

Do not offer the cardioprotective effects

SummaryIn English

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