Principles of effective use of non-steroidal anti-inflammatory drugs

Abstract

The article provides an overview of references on the rational use of nonsteroidal anti-inflammatory drugs (NSAIDs) in modern medicine. Nonsteroidal anti-inflammatory drugs are a group of drugs with different chemical structures (mostly acid derivatives) that have anti-inflammatory, analgesic, antipyretic, antiplatelet (acetylsalicylic acid, acetylsalicylate, ketoprofen, diclofenac sodium, niflumic acid, indomethacin) effects. NSAIDs are divided according to the selectivity of action relative to cyclooxygenase (COX) isoforms: non-selective COX inhibitors, selective COX-1 inhibitors, approximately equal inhibition of COX-1 and COX-2, selective COX-2 inhibitors. They are characterized by general pharmacological properties: high degree of absorption in the gastrointestinal tract; a high degree of binding to albumins; approximately the same volume of distribution; the ability to accumulate in the focus of inflammation. Indications for NSAIDs use are: acute arthritis and chronic arthritis; acute and chronic pain syndrome of various nature (lower back pain syndrome, joint and soft tissue injuries, migraine, dysmenorrhea, preoperative and postoperative pain, renal colic, fever in various rheumatic and non-rheumatic diseases). Аdditional indications for prescribing NSAIDs are: pleurisy, pericarditis, erythema nodosum, polycystic lung disease, sciatica. The most frequent and dangerous side effects include gastrointestinal, kidney complications. Special attention is paid to the cardiovascular safety of NSAIDs and, above all, COX-2 inhibitors because of risk of cardiovascular events. The most effective drug with the best tolerability should be selected for a specific patient. Before starting NSAID therapy, the patient's age, comorbidities, previous medical or surgical history, concomitant use of medications (including antiplatelet agents, anticoagulants, corticosteroids, ACE inhibitors, and selective serotonin reuptake inhibitors), H. pylori infection, and blood pressure monitoring should be considered. Keywords: inflammation, pain, side effects, gastropathy, selectivity.