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Classification and Mechanism of NSAIDs
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are commonly used medications that inhibit cyclooxygenase (COX) enzymes, reducing inflammation, pain, and fever.
Classification of NSAIDs
- Non-Selective COX Inhibitors: Aspirin, Ibuprofen, Naproxen, Diclofenac, Indomethacin
- Selective COX-2 Inhibitors: Celecoxib, Etoricoxib, Meloxicam
- Preferential COX-2 Inhibitors: Nimesulide, Nabumetone
- Salicylates: Aspirin (Acetylsalicylic acid)
- Others: Paracetamol
Mechanism of Action
NSAIDs inhibit the cyclooxygenase (COX) enzymes:
- COX-1: Found in most tissues, maintaining gastric, renal, and platelet functions.
- COX-2: Induced during inflammation, leading to prostaglandin production and inflammation.
By inhibiting COX, NSAIDs reduce prostaglandin synthesis, thus alleviating pain, inflammation, and fever.
Therapeutic Uses
- Analgesic: For mild to moderate pain (e.g., headaches, musculoskeletal pain).
- Antipyretic: For fever reduction.
- Anti-inflammatory: Used in arthritis, gout, and inflammatory conditions.
- Antiplatelet: Aspirin is used to prevent thrombosis by inhibiting COX-1 in platelets.
Adverse Effects
- Gastrointestinal (GI) Effects: Dyspepsia, ulcers, and GI bleeding.
- Renal Effects: Impaired renal function, especially in those with preexisting renal conditions.
- Cardiovascular Effects: Increased risk of heart attacks and strokes with certain COX-2 inhibitors.
- Allergic Reactions: Rash and anaphylaxis, especially with aspirin sensitivity.
- Other: Hepatotoxicity, prolonged bleeding time.
Contraindications
- Peptic Ulcer Disease or GI Bleeding: Risk of exacerbation.
- Renal Impairment: Potential to worsen renal function.
- Cardiovascular Disease: Especially with COX-2 inhibitors.
- Aspirin Sensitivity or Allergy: Can provoke hypersensitivity reactions.
- Pregnancy (third trimester): May cause complications in fetal development.
Illustration of NSAID Mechanism
