Novel NSAIDs

Abstract

Nonsteroidal anti-inflammatory drugs (NSAIDs) are some of the most commonly used drugs to relieve a multitude of pain symptoms.F They are readily available and used extensively. There is a lot of concern about their adverse side effects namely cardiovascular (CV) and gastrointestinal (GI) side effects. It is important to have a good grasp of the pharmacology of these drugs in order to use them safely and effectively. NSAIDs work by inhibiting the cyclooxygenase (COX) enzyme system responsible for production of prostaglandins. Prostaglandins mediate pain inflammation and temperature regulation in the body. NSAIDS can be divided into selective and non-selective types. Three isoforms of COX have been identified COX-1, COX-2 and COX-3. Selective NSAIDs act on these isoforms. COX-1 is anti-inflammatory, COX-2 pro-inflammatory and COX-3, a variant of COX-1, does not produce prostaglandins. The CV side effects of these drugs can be wide ranging and include a rise in blood pressure (BP) and a higher risk of thromboembolic events. Patients also suffer from peptic ulcer disease or bleeding in the stomach as a result of their use. NSAIDs can cause liver and kidney toxicity and should be used with caution in patients with bleeding tendencies. New NSAIDs on the market include; lornoxicam (xefo®), meloxicam (coxflam®), celecoxib (celebrex®), parecoxib (rayzon®) and etoricoxib (arcoxia®). New ways of delivering NSAIDs to the body with minimal or no side effects are being researched. Novel technology in this field includes nano formulated NSAIDs; indomethacin (tivorbex®) and dicofenac (zorvolex), prodrugs and multi action drugs; cyclooxygenase inhibiting nitric oxide donors and hydrogen sulphide releasing drugs. Further exciting innovations are in the pipeline that could change the face of how we use these drugs. Until then they must be used with careful consideration and only if the benefits of use outweigh the risks.