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Non-steroidal anti-inflammatory drugs

Anti-inflammatories are the most prescribed medications to treat pain and inflammation , are used for diseases and symptoms such as:

They are also known as NSAIDs (for example, Dermatop, whose trade name is doril).

Most people are familiar with medicines that can be bought without a prescription, such as aspirin and an eraser. 
NSAIDs are not analgesic, but they help reduce:

  • The inflammation,
  • fever .

Another action of NSAIDs is to prevent blood clotting, so they may have a protective effect against heart disease.


How they work

Anti-inflammatories work to decrease inflammation, pain and fever. 
NSAIDs block the enzymes in the body that help produce prostaglandins, chemicals that cause inflammation. 
First-generation anti-inflammatories such as ibuprofen block two of these enzymes:

  • COX-1,
  • COX-2.

Celecoxib (Celecoxib) mainly affects COX-2 and causes fewer side effects.



For which diseases are anti-inflammatory drugs used?

NSAIDs are primarily used to treat:

  • The inflammation,
  • The mild to moderate pain,
  • fever .

In particular, they may be taken to treat:

  1. Headaches,
  2. Arthritis,
  3. Sports injuries,
  4. Tendonitis (for example epicondylitis , Iliotibial Band Syndrome , etc.),
  5. The menstrual cramps .

The ketorolac (Toradol) is only used for short term treatment of acute and severe pain that otherwise would be treated with opioids. 
Aspirin is used to prevent blood clotting and prevent strokes  and heart attacks in people at high risk.


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Dosage of anti-inflammatories

All anti-inflammatories have a dose and a specific frequency range. 
The dosage of the over-the-counter active ingredient, ie sold over the counter, is often less than the same prescription medication. 
For example, the best-selling prescription ibuprofen doses are 400, 600 and 800 mg, but the maximum non-prescription dose is 200 mg. 
When you take a lower dose, this effect is lighter.

Non-prescription anti-inflammatories may be effective enough for acute conditions such as:

For chronic health problems like arthritis or lupus, the rheumatologist prescribes these medications in higher doses and for a longer time. 
Always ask your doctor what is the purpose of taking these medicines:

  • If the goal of taking NSAIDs is to resolve the inflammation , you will probably need to take larger doses at regular intervals.
  • If the main goal is to relieve pain , it is possible to take lower doses only when you feel much pain.

The transdermal patches must be applied directly to the painful area (e.g., in the cervical area in case of pain in the neck ). 
The adhesive should be kept for about 8 hours because the absorption of the drug is slow.

As a local action medication, an ointment or anti-inflammatory cream (eg emulgel) may be applied over the painful area. 
The doctors prescribing this drug in the form of a cream for treating back pain , joint pain , and muscle  because it has less counter-indications than the pill.

Among natural remedies, it is also possible to use natural herbal anti-inflammatories ; some of the most effective are:

  • Arnica montana,
  • Devil’s Claw,
  • Aloe vera ,
  • Echinacea.


How are non-steroidal anti-inflammatory drugs prescribed?

Medications are prescribed in different doses depending on the disease being treated. 
Intake may vary from one to four times a day, depending on how long the medication stays in the body.

  1. The doctor may prescribe higher doses of medication to treat certain diseases, for example rheumatoid arthritis. Often this disease causes significant inflammation with heat, swelling and  stiffness of the joints.
  2. The lower doses may be appropriate for muscle injury and arthrosisbecause there is often less swelling and the joints are not hot or red.

The doctor may prescribe different types of anti-inflammatories before finding the most effective. 
It is sometimes not enough to take non-steroidal anti-inflammatories, so your doctor may prescribe cortisone medications that are stronger, even if they have more side effects.


Are there differences between anti-inflammatories?

Anti-inflammatories vary according to:

  • The power
  • The duration of the action
  • The way they are eliminated from the body
  • The ability to inhibit COX-1
  • The ability to cause ulcers or promote bleeding .

The more an NSAID blocks the COX-1 enzyme , the greater the chance of developing an ulcer and bleeding. 
There is an NSAID called celecoxib (CELEBRA) that:

  • It blocks the COX-2,
  • It has little effect on COX-1.

Therefore it is classified as a selective COX-2 inhibitor. 
Selective COX-2 inhibitors cause fewer bleeds and ulcers than other anti-inflammatory drugs.

The aspirin is one NSAID, because not only can be used in many cases, but because it is a unique anti-inflammatory drug that inhibits coagulation for a long period (4-7 days). 
Given that it has this effect, it is an ideal medicine to prevent blood clots that cause heart attacks and strokes. 
Most non-steroidal anti-inflammatory drugs inhibit coagulation for a few hours.

The ketorolac (Toradol) is a very strong anti-inflammatory that can be used for strong acute pain. 
Ketorolac causes ulcerations more often than other anti-inflammatories, so it is not prescribed for more than five days.

Although NSAIDs have a similar mechanism of action, individuals who do not respond to one drug may benefit from one another. 
The list of anti-inflammatories is long, usually used:

  • Ibuprofen,
  • Naproxen,
  • Diclofenaco,
  • Nimesulida.

The paracetamol or acetaminophen (e.g., Tylenol) is not an anti-inflammatory non – steroidal drug, but is:

  • An analgesic,
  • An antipyretic (used to reduce fever ).


The most prescribed medicines

Ibuprofen (for example Advil)
Ibuprofen was one of the first non-steroidal anti-inflammatory drugs and can be bought without a prescription. 
For patients with low back pain, ibuprofen is most prescribed to relieve:

  • To rigidity ,
  • Numbness,
  • The inflammation,
  • Mild or moderate pain.

The frequent situations in which ibuprofen can be recommended are:

  • Stress pain (such as muscle soreness felt after sports activities, housework, etc.).
  • Discomfort caused by strains on muscles in the lumbar spine
  • Torticollis
  • Pain caused by an infection of the urinary tract, eg cystitis .

Ibuprofen has the effects of aspirin on the stomach, so people with active ulcer and stomach pain should avoid this medicine. 
It is best to take ibuprofen during meals to minimize the chance of developing an ulcer in the stomach.

Ibuprofen also has a slight effect of diluting blood that lasts for a few hours and may reduce the effectiveness of some medicines for:

  • Blood pressure,
  • Diuretics

Generally, the recommended dose for ibuprofen is 400 mg every eight hours. 
Doses of prescription drugs can reach 800 mg of ibuprofen every 8 hours.

Naproxen (Naprosyn®, Flanax®, Napronax®, Naprox®, etc.) Naproxen
is available:

  1. As an over-the-counter drug (for example the Aleve brand),
  2. As a medicine that requires prescription (for example, the Naprosyn brand).

For patients with spine pain , shoulder pain , etc., it works by reducing the proteins that cause inflammation and pain.


  • Dilutes the blood , so individuals who are taking blood anticoagulants should avoid this medicine because it can cause bleeding.
  • It can cause some gastrointestinal side effects , so people with active ulcer or stomach pain should avoid this drug.

It is best to take naproxen during meals to reduce the chance of stomach pain. 
The usual adult dose is 1 250-500 mg tablet twice daily.

The  Profenid ( ketoprofen ) is an anti-inflammatory used mainly for:

In the case of fever, it has an antipyretic effect (reduces body temperature). 
Pharmaceutical form and presentation:

  • Oral solution (drops),
  • Capsule,
  • Tablets,
  • Suppositories


How long does treatment with anti-inflammatory drugs last?

Generally, doctors recommend anti-inflammatories only for 4/6 days, or when there is a need to reduce the side effects to a minimum.


What are the side effects of anti-inflammatories?

The most common side effects are:

Anti-inflammatories can also cause swelling in the arms and legs due to fluid retention . 
The most serious side effects include:

People who are allergic to anti-inflammatories may experience dyspnoea ( shortness of breath ) after taking this medicine. 
People with asthma are more at risk of developing an allergic reaction to anti-inflammatories. 
Administration of aspirin to children may cause Reye’s syndrome, a potentially fatal liver disease.

The trade names of Acetylsalicylic Acid are: Aspirin, Aspirin buffered, Aspirin prevent, Bufferin cardio, etc.

Non-steroidal anti-inflammatory drugs should not be used to treat pain caused by coronary artery bypass surgery .

Anti-inflammatories should be avoided during pregnancy and it is best not to take during breastfeeding because a small amount can end up in breast milk. 
The use of anti-inflammatories in children is not recommended.


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

There is no way to completely avoid the side effects of any medication, but the doctor can minimize the risk of developing side effects of NSAIDs.

For example:

  • Take acetaminophen (acetaminophen) instead of NSAIDs to relieve pain if your doctor believes it is not suitable for an anti-inflammatory drug.
  • Take the minimum amount needed for the disorder to be treated.

Stomach and duodenal ulcer 
Alila / bigstockphoto.com

Ask your doctor if you can take a gastroprotective medicine to reduce the risk of stomach ulcers. 
Some medicines combine anti-inflammatories with a gastroprotectant in the same tablet. 
In case of persistent or unusual pain in the stomach after taking an anti-inflammatory, it is necessary to inform the doctor immediately.


Which drugs interact with anti-inflammatories?

  • Anti-inflammatory drugs may decrease the effects of medications used to treat hypertension because NSAIDs may raise blood pressure.
  • Anti-inflammatories reduce the elimination of lithium ( Carbolitium ) and methotrexate (Rheumatrex) that increase hepatic toxicity, and also reduce the action of diuretics, because they reduce blood flow to the kidneys.
  • When it is given with other medicines, such as Warfarin or Coumadin , which dilute the blood, it increases the risk of complications. 
    Prolonged use of NSAIDs should be avoided in conjunction with medicinal products that increase coagulation time.
  • Non-steroidal anti-inflammatories also interact with alcohol , so it is best to avoid drinking alcohol (such as wine or beer) while taking ibuprofen or aspirin. 
    The risk is the irritation of the stomach lining.

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