Non-steroidal anti-inflammatory agent: Difference between revisions

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'''Non-steroidal anti-inflammatory agents''', also called '''non-steroidal anti-inflammatory drugs''' (NSAIDs) are defined as "anti-inflammatory agents that are not [[glucocorticoid|steroids]]. In addition to anti-inflammatory actions, they have analgesic, antipyretic, and platelet-inhibitory actions. They are used primarily in the treatment of chronic arthritic conditions and certain soft tissue disorders associated with [[pain]] and inflammation. They act by blocking the synthesis of [[prostaglandin]]s by inhibiting [[cyclooxygenase]], which converts arachidonic acid to cyclic endoperoxides, precursors of prostaglandins. Inhibition of prostaglandin synthesis accounts for their analgesic, antipyretic, and platelet-inhibitory actions; other mechanisms may contribute to their anti-inflammatory effects. Certain NSAIDs also may inhibit lipoxygenase enzymes or phospholipase C or may modulate T-cell function."<ref name="title-">{{cite web |url=http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?term=Non-steroidal+anti-inflammatory+agents |title=Non-steroidal anti-inflammatory agents|author=National Library of Medicine |accessdate=2007-11-19 |format= |work=}}</ref>
The clinical characteristics of NSAISs have been reviewed.<ref>Chou R, Helfand M, Peterson K, Dana T. (2004). [http://derp.ohsu.edu/final/NSAIDS_Final_Report_Update%2032.pdfDrug Class Review of Cyclo-oxygenase (COX)-2 Inhibitors and Non-steroidal Anti-inflammatory Drugs (NSAIDS)]. [http://www.ohsu.edu/ohsuedu/research/policycenter/ Center for Evidence-based Policy]: [http://www.ohsu.edu/ohsuedu/research/policycenter/DERP/Drug Effectiveness Review Project (DERP)]</ref>
==Classification==
===Non-selective inhibitors of clooxygenase===
These drugs inhibit both [[cyclooxygenase]] isozymes. An example is [[aspirin]].
===Selective inhibitors of cyclooxygenase 2===
{{main|Cyclooxygenase 2 inhibitors}}
==Adverse reactions==
===Gastrointestinal===
NSAIDs may contribute to gastrointestinal ulceration including [[peptic ulcer disease]].<ref name="pmid1987872">{{cite journal |author=Griffin MR, Piper JM, Daugherty JR, Snowden M, Ray WA |title=Nonsteroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons |journal=Ann. Intern. Med. |volume=114 |issue=4 |pages=257–63 |year=1991 |month=February |pmid=1987872 |doi= |url= |issn=}}</ref><ref name="pmid7907735">{{cite journal |author=García Rodríguez LA, Jick H |title=Risk of upper gastrointestinal bleeding and perforation associated with individual non-steroidal anti-inflammatory drugs |journal=Lancet |volume=343 |issue=8900 |pages=769–72 |year=1994 |month=March |pmid=7907735 |doi= |url= |issn=}}</ref> A [[meta-analysis]] concluded "[[ibuprofen]] was associated with the lowest relative risk, followed by [[diclofenac]]. Azapropazone, tolmetin, ketoprofen, and [[piroxicam]] ranked highest for risk and [[indomethacin]], [[naproxen]], [[sulindac]], and [[aspirin]] occupied intermediate positions. Higher doses of ibuprofen were associated with relative risks similar to those withnaproxen and indomethacin."<ref name="pmid8664664">{{cite journal |author=Henry D, Lim LL, Garcia Rodriguez LA, ''et al'' |title=Variability in risk of gastrointestinal complications with individual non-steroidal anti-inflammatory drugs: results of a collaborative meta-analysis |journal=BMJ |volume=312 |issue=7046 |pages=1563–6 |year=1996 |month=June |pmid=8664664 |pmc=2351326 |doi= |url=http://bmj.com/cgi/pmidlookup?view=long&pmid=8664664 |issn=}}</ref>
The risk of [[peptic ulcer disease]] is higher if NSAIDs are combined with [[corticosteroid]]s.<ref name="pmid2012355">{{cite journal |author=Piper JM, Ray WA, Daugherty JR, Griffin MR |title=Corticosteroid use and peptic ulcer disease: role of nonsteroidal anti-inflammatory drugs |journal=Ann. Intern. Med. |volume=114 |issue=9 |pages=735–40 |year=1991 |month=May |pmid=2012355 |doi= |url= |issn=}}</ref><ref name="pmid7907735">{{cite journal |author=García Rodríguez LA, Jick H |title=Risk of upper gastrointestinal bleeding and perforation associated with individual non-steroidal anti-inflammatory drugs |journal=Lancet |volume=343 |issue=8900 |pages=769–72 |year=1994 |month=March |pmid=7907735 |doi= |url= |issn=}}</ref>
[[Non-steroidal anti-inflammatory agent]]s should be avoided in [[geriatrics]] according to [[clinical practice guideline]]s.<ref name="urlThe American Geriatrics Society - Education - AGS Clinical Practice Guideline: Pharmacological Management of Persistent Pain in Older Persons">{{cite web |url=http://www.americangeriatrics.org/education/executive_summary.shtml |title=The American Geriatrics Society - Education - AGS Clinical Practice Guideline: Pharmacological Management of Persistent Pain in Older Persons |author= |authorlink= |coauthors= |date= |format= |work= |publisher= |pages= |language= |archiveurl= |archivedate= |quote= |accessdate=}}</ref>
===Renal===
NSAIDs may cause [[acute kidney injury]] due to acute tubular necrosis. Although this is usually interstitial nephritis, NSAIDS can also cause minimal-change disease in the glomerulus.<ref name="pmid17928602">{{cite journal |author=Rabb H, Colvin RB |title=Case records of the Massachusetts General Hospital. Case 31-2007. A 41-year-old man with abdominal pain and elevated serum creatinine |journal=N. Engl. J. Med. |volume=357 |issue=15 |pages=1531–41 |year=2007 |pmid=17928602 |doi=10.1056/NEJMcpc079024}}</ref>
Damage from NSAIDS may rarely occur after just a few doses.<ref name="pmid17928602">{{cite journal |author=Rabb H, Colvin RB |title=Case records of the Massachusetts General Hospital. Case 31-2007. A 41-year-old man with abdominal pain and elevated serum creatinine |journal=N. Engl. J. Med. |volume=357 |issue=15 |pages=1531–41 |year=2007 |pmid=17928602 |doi=10.1056/NEJMcpc079024}}</ref>
==Effectiveness==
==Effectiveness==
===Combined with acetaminophen===
===Combined with acetaminophen===
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For reducing [[fever]], acetaminophen combined with [[ibuprofen]] may be better than either drug alone according to a [[randomized controlled trial]].<ref name="pmid18765450">{{cite journal |author=Hay AD, Costelloe C, Redmond NM, ''et al'' |title=Paracetamol plus ibuprofen for the treatment of fever in children (PITCH): randomised controlled trial |journal=BMJ |volume=337 |issue= |pages=a1302 |year=2008 |pmid=18765450 |pmc=2528896 |doi= |url=http://bmj.com/cgi/pmidlookup?view=long&pmid=18765450 |issn=}}</ref>
For reducing [[fever]], acetaminophen combined with [[ibuprofen]] may be better than either drug alone according to a [[randomized controlled trial]].<ref name="pmid18765450">{{cite journal |author=Hay AD, Costelloe C, Redmond NM, ''et al'' |title=Paracetamol plus ibuprofen for the treatment of fever in children (PITCH): randomised controlled trial |journal=BMJ |volume=337 |issue= |pages=a1302 |year=2008 |pmid=18765450 |pmc=2528896 |doi= |url=http://bmj.com/cgi/pmidlookup?view=long&pmid=18765450 |issn=}}</ref>
==References==
<references/>

Revision as of 21:03, 16 September 2009

Effectiveness

Combined with acetaminophen

For lumbalgia, acetaminophen one gram orally four times a day combined with diclofenac, a non-steroidal anti-inflammatory agent, was not better than acetaminophen alone in a randomized controlled trial.[1]

For reducing fever, acetaminophen combined with ibuprofen may be better than either drug alone according to a randomized controlled trial.[2]

  1. ↑ Hancock MJ, Maher CG, Latimer J, et al (2007). "Assessment of diclofenac or spinal manipulative therapy, or both, in addition to recommended first-line treatment for acute low back pain: a randomised controlled trial". Lancet 370 (9599): 1638–43. DOI:10.1016/S0140-6736(07)61686-9. PMID 17993364. Research Blogging.
  2. ↑ Hay AD, Costelloe C, Redmond NM, et al (2008). "Paracetamol plus ibuprofen for the treatment of fever in children (PITCH): randomised controlled trial". BMJ 337: a1302. PMID 18765450. PMC 2528896. [e]
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