Anti-inflammatory drugs

Anti-inflammatory drugs or nonsteroidal anti-inflammatory drugs (NSAIDs for short) are the drugs most commonly used to treat pain and inflammation in conditions such as arthritisback pain, neck pain, toothache, etc.

Are used (for example, the active ingredient nimesulide, trade name Aulin (CH).
Most individuals are familiar with over-the-counter medications, such as aspirin and ibuprofen.

The NSAIDs are not pure painkillers, but also fight inflammation and fever.
In addition, the clotting ability of the blood is restricted, which can be advantageous in some cases, but rather disadvantageous in other cases.
Some NSAIDs, such as aspirin, may have a protective effect on heart disease because they reduce blood clotting.


What is their mode of action?

The NSAIDs have an anti-inflammatory, analgesic and antipyretic effect.
They inhibit the body’s own enzymes that promote the production of prostaglandins, which are chemical substances responsible for pain and inflammation.
The older anti-inflammatory drugs such as ibuprofen inhibit two of these enzymes: COX-1 and COX-2, while celecoxib (Celebrex) is a selective COX-2 inhibitor.

In which diseases are nonsteroidal anti-inflammatory drugs used?

The NSAIDs are mainly used to combat inflammation, mild to moderate pain and fever.
Areas of application are: headachesarthritis, sports injuries, tendonitis (e.g. tennis elbow, runner’s knee, etc.) and menstrual cramps.
The drug ketorolac (toradol) is only used for short therapy for severe and acute pain as an alternative to opioids.
Aspirin is taken to inhibit blood clotting and prevent strokes and heart attacks from high-risk patients.


Each drug from the group of NSAIDs has its own characteristics in terms of dose and frequency of use.

The dose of over-the-counter medications is often the reduced potency of the same prescription drug.
For example, ibuprofen is usually prescribed in a dosage of 400, 600 and 800 mg, in the over-the-counter version the amount of medicine is 200mg.
At lower dosages, the effect is too weak, but if the medically recommended amount is taken, this drug is a good anti-inflammatory.
Over-the-counter NSAIDs have a sufficiently strong effect to treat acute ailments such as sprains, strains, inflammatory back painheadaches and menstrual cramps.

For chronic health problems, such as arthritis or lupus, the doctor will prescribe drugs with higher potency and prolonged use.
You should always inform your family doctor about the treatment purpose for which the drug should be used.
If the NSAIDs are to fight inflammation, higher-dose agents must probably be taken at regular intervals.
If the main task is to relieve pain, a lower dosage may be sufficient and it is only taken when necessary.

Pain patches are applied directly to the affected area (e.g. for neck pain) and must remain there for about 8 hours, as the active ingredients are absorbed slowly.

As a topical application, an anti-inflammatory cream or ointment can also be applied to the pain zone (e.g. Voltaren Emulgel). Creams are mainly prescribed for back, joint and muscle pain because they have fewer side effects than tablets.

Anti-inflammatory medicinal plants can also be used as natural remedies; the best effect show arnica, devil’s claw, true aloe and coneflower.

According to what criteria are NSAIDs prescribed?

The nonsteroidal anti-inflammatory drugs are prescribed in different doses depending on the disease.
The dose is one to four times a day, depending on how long the respective drug remains in the body.
The doctor may prescribe a higher dosage if, for example, rheumatoid arthritis is present, because this condition often causes serious inflammation with overheating, swelling, redness and stiffness of the joints.
A lower dosage may be sufficient for muscle injuries and osteoarthritis, because usually the swelling is lower and the joints are not overheated or reddened.
No single NSAIDs can guarantee treatment success.
It is possible that the doctor will have to prescribe various anti-inflammatories until a remedy is found that shows effect.

Sometimes taking nonsteroidal anti-inflammatory drugs is not enough; then the doctor may prescribe cortisone preparations that have a stronger effect, but also have more side effects.

What are the differences between NSAIDs?

The nonsteroidal anti-inflammatory drugs differ in their strength, duration of action, the way they are excreted by the body, their ability to inhibit COX-1 and their tendency to cause ulcers and bleeding.
The more a remedy inhibits the enzyme COX-1, the greater the possibility of developing peptic ulcer and bleeding.

One of the NSAIDs, the active ingredient celecoxib (Celebrex), inhibits the enzyme COX-2 but has little effect on COX-1 and is thus classified as a selective COX-2 inhibitor.
The selective COX-2 inhibitors cause less bleeding and ulcers than the other NSAIDs.

Aspirin is unique in the group of NSAIDs, not only because of its versatility, but because it is the only remedy that inhibits blood clotting for a longer period of time (4 to 7 days).
This long-term effect makes it an ideal drug for preventing blood clots, which can cause heart attacks and strokes.
Most NSAIDs prevent blood clotting for a few hours.

Ketorolac (Toradol) is a very strong agent and is used for very severe, acute pain, which can also be treated with anesthetics.
Ketorolac causes stomach ulcers more often than the other nonsteroidal anti-inflammatory drugs. That is why it is prescribed no longer than for five days.
Although NSAIDs have a similar mechanism of action, patients may not respond to one particular agent, but may experience great effects on another.

The list of nonsteroidal anti-inflammatory drugs is long, commonly used are:

  • ibuprofen (Dolormin),
  • naproxen (Aleve, etc.),
  • ketoprofen (alrheum),
  • diclofenac (Voltaren),
  • Nimesulide.

Paracetamol (for example, Ben-u-ron) does not belong to the group of nonsteroidal anti-inflammatory drugs, it is an analgesic (analgesic) and antipyretic agent (antipyretic).

Commonly prescribed medications:

Ibuprofen (e.g. Dolormin and numerous generics)
Ibuprofen was one of the first nonsteroidal anti-inflammatory drugs and is available without a prescription.
In patients with low back pain, ibuprofen is often used to relieve stiffness, numbness, inflammation, and mild to moderate lumbar pain.

Ibuprofen is especially recommended in the following situations:

  • Pain caused by overexertion (for example, muscle pain as a result of sports activities, household activities, shoveling snow, etc.).
  • Complaints caused by muscle tears in the lumbar region.
  • Stiff neck.
  • Pain due to a urinary tract infection, e.g. cystitis.

Ibuprofen has the same effect on the stomach as aspirin, people with stomach ulcers or a sensitive stomach should avoid ibuprofen.
Ibuprofen should be taken during meals to minimize the risk of stomach irritation.
Ibuprofen also has a mild blood-thinning effect that lasts a few hours, and it may reduce the effectiveness of some blood pressure and diuretic drugs (diuretics).
As a rule, the recommended dosage of ibuprofen is 400 mg at an interval of eight hours.
The dosage prescribed by the doctor can go up to 800 mg every eight hours.

Naproxen (Aleve, Proxen, Dysmenalgit, numerous generics, etc.)
Naproxen is available without a prescription (e.g. under the trade name Aleve) or by prescription (e.g. Dysmenalgit).
In patients with back, shoulder pain, etc., it reduces the proteins that cause inflammation and pain in the body.
Naproxen dilutes the blood, those who take blood liquefaction or anticoagulants should avoid this active ingredient because its effect can cause bleeding.
Naproxen can also cause side effects in the gastrointestinal area, people with stomach / intestinal ulcer and sensitive stomach should refrain from taking it.
For the prevention of stomach pain, it is recommended to take naproxen during meals.
Normally, the dosage for adults is one tablet (250-500mg), twice a day.

Ketoprofen (Alrheumun)
Ketoprofen is a commonly used anti-inflammatory agent and is mainly used for headachestoothaches, sore throats and joint pain.
It also has an antipyretic (antipyretic) effect.
Ketoprofen is offered in the form of tablets, capsules, spray or suppositories.

How long does it take to take the anti-inflammatories?

Anti-inflammatory drugs should be taken for a maximum of 4-6 days or “as needed” to minimize side effects.

What are the side effects of nonsteroidal anti-inflammatory drugs?

The most common side effects include:

The NSAIDs can also cause swelling of the legs and arms due to water retention.
The more serious side effects are: ulceration, bleeding, renal insufficiency and – rarely – hepatic insufficiency.
Anyone who is allergic to the non-starsteroidal anti-inflammatory drugs may suffer from shortness of breath after taking the drug.
In asthmatics, the risk of developing an allergic reaction is higher.

In children and adolescents, taking aspirin to treat chickenpox or flu can cause Reye’s syndrome, which is a life-threatening liver disease.

In addition to aspirin, acetylsalicylic acid is marketed, for example, under the following trade names: Acesal, Alka Seltzer, Aspirin, Aspirin Cardio, Aspro (CH, A), ASS-ratiopharm, Eudorlin, Godamed, HerzASA, Miniasal, Togal-ASA.

NSAIDs must not be used to treat pain caused by coronary artery bypass.

The NSAIDs should not be taken during pregnancy and preferably not during breastfeeding, because a small proportion can pass into breast milk.
The administration of nonsteroidal anti-inflammatory drugs to children is not recommended.

How can the side effects of anti-inflammatories be minimized?

There is no way to completely eliminate the side effects of any medication, but the primary care physician can minimize the risk of developing unwanted side effects of NSAIDs.

Here are some examples:
Taking paracetamol (Ben-u-ron) instead of a nonsteroidal anti-inflammatory drug to relieve pain if, in the opinion of the doctor, an anti-inflammatory agent can be dispensed with.
Always take only the minimum amount necessary for treatment.

One should ask the doctor whether a preparation to protect the stomach can be taken to reduce the risk of a stomach ulcer.
Some drugs are combination preparations in which stomach protection is already included.
The trade names of stomach protectors are: Antra, Gastracid, Nexium, Rifun, Pantozole, Pantoloc, Agopton, Lanzor, Pariet, etc. In case of persistent or unusual pain after taking an NSAID, the doctor must be informed immediately.

What are the interactions between nonsteroidal anti-inflammatory drugs and other drugs?

The NSAIDs can reduce the effectiveness of antihypertensive drugs because they can increase blood pressure.
The nonsteroidal anti-inflammatory drugs reduce the elimination of the active ingredients lithium and methotrexate (bendatrexate), which lead to liver toxicity, in addition, they reduce the effect of the diuretics, reducing blood flow to the kidneys.

If blood thinners such as warfarin (Coumadin) are also taken, the risk of complications increases.
Prolonged use of NSAIDs in conjunction with drugs that increase bleeding time should be avoided.

Nonsteroidal anti-inflammatory drugs also interact with alcohol; while taking ibuprofen or aspirin, alcohol should be abstained.
The danger lies in the irritation of the gastric mucosa.

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