Main criteria of Non-narcotic anti-inflammatory drugs:
- They don’t produce narcosis.
- They block inflammatory process.
- They produce anti-pyrexia.(Central effect)
- They have peripheral effects.
- They have least central effect.
- They have high therapeutic index(TI).
- As they block inflammatory process,they are used in:Rheumatoid arthritis,Osteoarthritis,Autoimmune diseases.
[A]Steroidal anti-inflammatory drugs(SAID):
- Glucocorticoids (more action).
- Mineralocorticoids (Less aciton).
[B]Non steroidal anti-inflammatory drugs(NSAID):
- Para-aminophenol group:Paracetamole.
- Propionic acid group:Ibuprofen,Ketoprofen,Fenoprofen.
- Fenamic acid group:Mefenamic acid.
- Salicylic acid group:Asprin,Trisalicylate.
- Acetic acid group:Indomethacin,Diclofenac,Tolmetin.
- Enolic acid group:Phenylbutazone,Piroxicam.
- Non-acidic drug:Nabumetone.
- New generation drug:Rofecoxib,Celecoxib,Nimesulide. (Ref:Bennett-10th)
[A]Strong anti-inflammatory agents:
- Salicylic acid derivatives:Asprine,Diflunisal.
- Acetic acid derivatives:Indomethacin,Diclofenac,Etodolac,Ketorolac.
- Oxicum(Enolic acid):Pyroxicam,Tenoxicam.
- Pyrazolone derivatives:Phenylbutazon.
- Propionic acid Ibuprofen,Ketoprofen,Fenoprofen,Flurbiprofen.
- Fenamic acid:Mefenamic acid.
- Para aminophenol group:Paracetamole.
NSAIDs are usually used for the treatment of acute or chronic conditions where pain and inflammation are present. Research continues into their potential for prevention of colorectal cancer.
NSAIDs are generally used for the symptomatic relief of the following conditions:
• Rheumatoid arthritis
• Inflammatory arthropathies (e.g., ankylosing spondylitis, psoriatic arthritis, Reiter’s syndrome)
• Acute gout
• Dysmenorrhoea (menstrual pain)
• Metastatic bone pain
• Headache and migraine
• Postoperative pain
• Mild-to-moderate pain due to inflammation and tissue injury
• Muscle stiffness and pain due to Parkinson’s disease
• Pyrexia (fever)
• Renal colic
• They are also given to neonate infants whose ductus arteriosus is not closed within 24 hours of birth
Aspirin, the only NSAID able to irreversibly inhibit COX-1, is also indicated for inhibition of platelet aggregation. This is useful in the management of arterial thrombosis and prevention of adverse cardiovascular events. Aspirin inhibits platelet aggregation by inhibiting the action of thromboxane A2.
Common side effects of NSAID:Adverse effects are generally quite similar for all of the NSAIDs:
- Central nervous system:Headaches,tinnitus and dizziness.
- cardiovascular:Fluid retention hypertension,edema and rarely,congestive heart failure.
nausea,vomiting and rarely ulcers or bleeding.
- Hematologic:Rare thrombocytopenia,neutropenia or even aplastic anemia.
- Hepatic:Abnomal liver function tests and rare liver failure.
- Rashes:All types pruritus.
- Renal:Renal insufficiency,renal failure and proteinuria.