Non-steroidal anti-inflammatory drugs (NSAIDs) are the most prescribed medicines to treat pain, fever, and other inflammatory processes. They are often used to provide relief for back, neck, and muscle pain temporarily. The anti-inflammatory medicine is very effective and helps to control pain at rest. NSAIDs such as Aspirin, Ibuprofen, Ketoprofen, and Naproxen can be bought over-the-counter while other NSAIDs that are available only by prescription include: Daypro, Indocin, Lodine, Naprosyn, and Voltaren.

When to Use Them?

NSAIDs are used to relieve symptoms that occur in high fever and ease minor inflammation. They are used to treat the pain of rheumatoid arthritis, osteoarthritis, and tendonitis and relieve muscle aches. It is used to reduce fever and muscle aches caused by the common cold. The drug is prescribed to treat dental pain, pain caused by gout, and bursitis. NSAIDs are used to treat menstrual cramps and relieve temporary pain due to sprains, joint or bone injuries, and strains.

How Do NSAIDs Work?

Pain - The NSAIDS blocks the effect of specific enzymes called cyclooxygenase (COX-1 and COX-2) enzymes, which are responsible for the synthesis of prostaglandins. The prostaglandins promote pain and inflammation. NSAIDs help to reduce the discomfort of pain and fever and reduce inflammation.
Fever - NSAIDs like Ibuprofen interfere with prostaglandins production through nonselective COX inhibition and regulate the fever.
Menstrual cramps - It inhibits the production of prostaglandins and reduces uterine shedding, leading to fewer cramps and bleeding.

The Onset of Action: The onset of NSAIDs takes about 30 minutes. This may vary from person to person.

NSAIDs are metabolized by the liver and are excreted into urine or bile. Enterohepatic recirculation occurs when NSAIDs and their conjugated metabolites are excreted into the bile or urine and then reabsorbed in the distal intestine.

How Are NSAIDs Taken?

NSAIDs are available as tablets, capsules, suppositories, creams, gels, and injections.

Topical NSAIDs such as Diclofenac solution 1.5 %, Diclofenac hydroxyethyl pyrrolidine 1.3 %, and Diclofenac sodium gel are used for treating pain due to soft-tissue injuries and osteoarthritis.

Parental NSAIDs such as intravenous Ibuprofen are given as a 30-minute infusion and used as a non-opioid analgesic.

NSAIDs are indicated for short-term use and should not be used continuously for more than ten days unless prescribed by the doctor. These medications may be prescribed in different doses and frequencies as per the medical condition of the patient. Therefore, it is advised not to increase the dose without asking the doctor.

What Are the Side Effects of NSAIDs?

There is a risk of side effects from NSAIDs

The common side effects may include,

Indigestion.
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Stomach ulcers.
Bloating.
Nausea.
Vomiting.
Headaches.
Dizziness.
Allergic reactions.
Drowsiness.
Diarrhea.

The rare side effects may include:

Difficulty concentrating.
Black stools
Bloody urine.
Ringing in ears.
Feeling lightheaded.
Problem with balance.
Heart failure.
Heart attacks.

What Precautions Should Be Taken When Taking NSAIDs?

It is important to tell the doctor if you have any of the following conditions before taking NSAIDs.

Pregnancy and Breastfeeding - NSAIDs should be avoided in the third trimester. It may be given in the first or second trimester only with the consultation of the doctor.
Hypersensitivity - It should be avoided in patients with NSAID hypersensitivity as well as in those who have had allergic reactions like urticaria and asthma to NSAIDs.
Children - Children with viral infections should not be given Aspirin or other Aspirin-containing products due to the risk of Reye's syndrome. Ibuprofen is the only NSAID approved for children over six months of age.

Hematologic Disorder - NSAIDs may cause hematologic adverse effects in patients with impaired platelet activity, like hemophilia, thrombocytopenia, and von Willebrand disease.
Stomach Ulcers - NSAIDs should be avoided in individuals with ulcers as they may cause bleeding in the gastric tract, including the stomach.
Hypertension - NSAIDs make the body retain fluid and decrease the function of the kidneys. This may cause an increase in blood pressure and raise the risk of heart attacks or stroke when given in high doses.
Kidney Disease - The medication should be used only with a doctor’s advice to patients with kidney disease as it may cause an increased risk of sudden kidney failure or progressive kidney damage.
Liver Cirrhosis - NSAIDs should be avoided in patients with cirrhosis because of the increased risk of hepatorenal syndrome.
Elderly - Seniors taking NSAIDs daily are at an increased risk of bleeding in the stomach, small intestine, or colon. The elderly taking blood thinners are especially at higher risk of bleeding.
Alcoholics - Taking alcohol with this medication increases the risk of gastrointestinal complications such as bleeding and ulcers.

What Are the Drug Interactions of NSAIDs?

NSAIDs may affect the efficacy of other medicines and can increase the risk of side effects.

Drug Interaction:

Low-dose Aspirin.
Warfarin.
Ciclosporin.
Diuretics.
Lithium.
Methotrexate.
Citalopram.
Fluoxetine.

Alcohol Interactions:

Taking alcohol with NSAIDs can increase the risk of side effects like gastrointestinal bleeding and stomach ulcers.

Interaction with Following Diseases:

Asthma - Nonsteroidal anti-inflammatory drugs are contraindicated in patients' history of asthma, urticaria, or other allergic-type reactions after taking Aspirin or other NSAIDs.
Fluid Retention - Therapy with NSAIDs should be administered cautiously in patients with preexisting fluid retention, hypertension, or a history of heart failure and should be monitored throughout treatment.
Skin Reactions - NSAIDs are contraindicated in patients with previous serious skin reactions as they can cause adverse reactions to Stevens-Johnson syndrome, toxic epidermal necrolysis, and exfoliative dermatitis, which can be fatal.
Renal Toxicities - Long-term use of NSAIDs can result in renal papillary necrosis and other renal injuries, especially elderly and those with impaired renal function.
Thrombosis - NSAIDs can cause an increased risk of cardiovascular thrombotic events like stroke and myocardial infarction in patients with a history of cardiovascular disease.
Anemia - Long-term therapy of NSAIDs may increase the risk of bleeding in patients predisposed to anemia or coagulation disorders. Hemoglobin should be monitored for signs of blood loss.
Hemostatic Abnormalities - NSAIDs prevent platelet aggregation and extend the bleeding time. The anti-inflammatory may be administered with caution in patients with coagulation defects, vitamin K deficiency, or severe hepatic impairment.

Conclusion:

Nonsteroidal anti-inflammatory drugs are non-opioid analgesics used primarily to treat mild symptoms of pain. They may be taken over-the-counter to get relief from headaches, fever from cold or flu, or period cramps. NSAIDs vary in potency, duration of action, how they are eliminated from the body, and their tendency to cause ulcers and promote bleeding. It is advised to discuss your medical condition and all your medications and supplements with your doctor to rule out possible adverse reactions to NSAIDs.

Frequently Asked Questions

1. Which Are the Most Effective NSAIDs for Pain?

NSAIDs are non-steroidal anti-inflammatory drugs. Aspirin, Ibuprofen, and Naproxen are some NSAIDs that are considered the most effective as they relieve pain and inflammation. Studies show that Diclofenac is the most effective and strongest NSAID for pain. Naproxen is a drug that is considered to have good efficacy with a low incidence of side effects.

2. How Do NSAIDs Work?

NSAIDs block an enzyme called cyclooxygenase. Cyclooxygenase produces prostaglandins, which cause pain and inflammation. NSAIDs help to reduce the discomfort of fever, reduce inflammation, and associated pain.

3. Which Is the Best Painkiller?

A pain killer is a medicine that helps to relieve pain and inflammation. Some painkillers can be received over the counter, while others require a prescription. The painkiller that works for a person in one kind of pain might not work for another person. It might not be applicable to another kind of pain as well.

4. Are NSAIDs Beneficial?

NSAIDs are safe if taken once in a while. However, if used continuously, it can cause damage to other parts of the body, like the liver or kidney. The symptoms begin to apply within a week of continuous use itself. The risk increases as the period of usage increases.

5. Which is the Safest NSAID?

Aspirin in low doses is considered relatively safe. It is not as dangerous as other NSAIDs in their full doses. They help in dulling the pain and reduce the inflammation and other discomforts caused. They are considered safe when used at moderate levels.

6. Can Paracetamol Be Considered an NSAID?

No, Paracetamol is not an NSAID. It belongs to the class of drugs called acetaminophen. It does not have the adverse effects of NSAIDs. Paracetamol has relatively less anti-inflammatory effects.

7. Is Paracetamol Safer Than Other NSAIDs?

Paracetamol at a therapeutic dose has good safety records. This is why it is preferred over NSAIDs. It is preferred in cases of renal impairment, chronic liver disease, hypertension, chronic heart failure, or aspirin-induced asthma. It is considered safe to take even during pregnancy.

8. Are NSAIDs Safe to Be Taken Daily?

NSAIDS are not safe to be consumed daily. It can cause kidney and liver damage during prolonged use. It should not be used for more than three days for a fever. In case of pain, it should be discontinued within ten days unless advised by the doctor.

9. What Are the Contra-Indications For NSAIDs?

People with renal impairment, chronic liver disease, hypertension, chronic heart failure, or Aspirin-induced asthma should avoid NSAIDs. It is contraindicated during pregnancy. Those who are allergic to Aspirin might be given NSAIDs after a doctor’s advice.

10. Which is the NSAID That Has the Highest Risk?

Diclofenac is an NSAID that is considered to have the highest cardiovascular risk. They are also known for liver damage. Etoricoxib is known to cause damage to the kidneys. They are contraindicated during pregnancy.

11. Which Is the NSAID Least Harmful to the Liver?

Low doses of Acetaminophen are considered safe in case of liver issues. Ibuprofen is the most harmful drug for the liver. It is one of the most common over-the-counter drugs available.

12. Is There A Best Time to Take NSAIDs?

Studies show that it is better to take NSAIDs during the night than during the day time. It should be avoided to be taken on an empty stomach. It can cause an upset stomach and ulcers if taken on an empty stomach. NSAIDS are not safe to be consumed daily.