People use nonsteroidal anti-inflammatory drugs, or NSAIDs, worldwide to treat a variety of conditions. The NSAIDs produce analgesia, or pain reduction; an antipyretic effect, or decrease in fever; and an anti-inflammatory outcome, or lessening of swelling. These drugs are the mainstay of treatment of rheumatic conditions, other degenerative inflammatory joint disorders and autoimmune diseases.
Prostaglandins
According to "Goodman & Gilman's The Pharmacological Basis of Therapeutics," the substance prostaglandin may arise from arachidonic acid, which contributes to the development of the inflammatory response and pain. Prostaglandins act as a mediator for inflammation and fail to produce inflammation directly. These prostaglandin mediators, called cyclooxygenase-2, or Cox-2, reduce fever, pain and inflammation. Over a dozen different prostaglandins exist in the human body, but Cox-2 responds to the actions of NSAIDs. NSAIDs also inhibit a second prostaglandin, cyclooxygenase-1, or Cox-1, but these may produce the unwanted effect of gastric ulcers. Prostaglandins build up over time and if allowed to persist, produce pain. Prostaglandins also promote bone growth and cartilage destruction, as observed in osteoarthritis.
Nonsteroidal Anti-Inflammatory Drugs
Nonsteroidal anti-inflammatory drugs target prostaglandins, or Cox-2, and produce antipyretic, analgesic and anti-inflammatory effects. The traditional NSAIDs---salicylic acid, or aspirin; ibuprofen, or Motrin; naproxen, or Aleve; etodolac, or Lodine; and indomethacin, or Indocin---work on both Cox-1 and Cox-2. Consequently, individuals taking traditional NSAIDs develop more gastric ulcer-adverse events. The newer drugs include celecoxib, or Celebrex; refecoxib, or Vioxx; valdecoxib. or Bextra; ketorolac, or Toradol; and diclofenac, or Voltaren. The newer agents produce less gastric ulceration than traditional NSAIDs, but according to Mark Shapiro, M.D., the newer agents---except for Celebrex---increase cardiovascular side effects of heart attacks and strokes.
Acetaminophen
"Kelley's Textbook of Rheumatology" reports that acetaminophen, or Tylenol, is similar to NSAIDs, as it acts to relieve pain and fever, but differs from NSAIDs in that it exerts no anti-inflammatory action and no effect on platelet function. Other names for acetaminophen include paracetamol and APAP. Concern arises if individuals use multiple acetaminophen-containing preparations, as severe hepatic damage may occur. Many cough and cold preparations contain acetaminophen.
New Indications for NSAIDs
According to the book "Molecular Cell Pharmacology," the newer NSAIDs came out in 1999, including the most popular Cox-2 selective drugs Vioxx and Celebrex, and by 2005, research showed a twofold increase in cardiovascular side effects of heart attacks and strokes with the drugs Vioxx and Bextra. The primary drug used currently is Celebrex.
"Molecular Cell Pharmacology" reports that new information came out in 2005 for using NSAIDs for reduction in the recurrence of colon polyps, and current research is studying the effect of NSAIDS on prevention of colon cancer. The book goes on to report that in 2010, initial research found the utility of Celebrex as a novel treatment for hypertension and that one small study found the anti-inflammatory effect of Celebrex helped reduce inflammation in subarachnoid hemorrhage. The future holds promise for many new uses of NSAIDs.
References
- "Kelley's Textbook of Rheumatology"; Prostaglandins; G.S. Firestein, M.D., et al.; 2008
- "Goodman & Gilman's The Pharmacological Basis of Therapeutics"; Analgesic-Antipyretic Agents; L.L. Brunton, Ph.D.; 2006
- "Molecular Pharmacology"; An Ion Channel Hypothesis to Explain Divergent Cardiovascular Safety; Mark Shapiro, M.D.; 2009
- "Molecular Cell Pharmacology"; Novel Actions of Nonsteroidal Anti-inflammatory Drugs; L.I. Brueggemann, et al.; 2010
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