Non-steroidal Anti-inflammatory Drugs (NSAIDs): How Do They Work?

Non-steroidal anti-inflammatory drugs (NSAIDs): how do they work?

Non-steroidal anti-inflammatory drugs, or NSAIDs for short, are one of the most commonly used drugs because of their strong analgesic properties and the ability to buy them without a prescription.

Non-steroidal anti-inflammatory drugs are also known as NSAIDs. These are drugs that, due to their action, have several applications. For example, they can make you insensitive to pain, reduce fever and inflammation, and have anti-platelet activity.

NSAIDs are one of the most prescribed drugs worldwide. Due to their analgesic effects, doctors prescribe them to treat rheumatoid pain, as well as inflammatory and degenerative diseases. Moreover, they are also recommended for migraines, toothache, and any inflammatory processes.

They are used extremely often, even to heal themselves. This is because they are sold over the counter and without medical supervision. This increases your risk of developing potential side effects.

In addition, it is worth noting that there is not a single non-steroidal anti-inflammatory drug that is better or safer than the others. With this in mind, you should not take them if you are already taking other prescription medications, as different medications can interact and cause problems.

Non-steroidal anti-inflammatory drugs and their mechanism of action

Once the body has absorbed the NSAIDs and they have passed through the liver, they bind to plasma proteins called albumin .

This is very important because if the patient suffers from hypoalbuminemia, the dose of the medication should be adjusted accordingly. All because there will be more drug in the blood that is not bound to a protein. Thus, its action will be stronger.

A person taking non-steroidal anti-inflammatory drugs
NSAIDs work by blocking the production of substances that are involved in inflammatory processes.

It follows that the free molecules of the drug induce the action of non-steroidal anti-inflammatory drugs. But how?

The way these drugs work is not unique. The incentives for their action may include:

  • Inhibition of the enzyme cyclooxygenase (COX). This is the main mechanism of action. Inhibiting this enzyme also inhibits the synthesis of prostaglandins, substances that act as messengers for inflammation.
  • Effects without prostaglandin mediation, such as inhibition of neutrophils in inflammation or inhibition of pro-inflammatory messengers such as cytokine-induced nitric oxide.
  • Apoptosis. Prostaglandins inhibit apoptosis, which may explain, at least in part, why some NSAIDs are associated with a reduced risk of developing certain types of cancer.

Classification of NSAIDs

NSAIDs can be classified according to whether they inhibit COX-2 or not. Thus, there are both non-selective and selective COX-2 inhibitors.

Some of the non-steroidal anti-inflammatory drugs that fall into the non-selective group include:

  • Salicylic acids. Acetylsalicylic acid or aspirin.
  • Pyrazolones. Metamizole.
  • Aminophenols. Paracetamol.
  • Propionic acid derivatives.  Ibuprofen.
  • Acetic acid derivatives. Indomethacin.
  • Also enolic acid derivatives (oxicam). Piroxicam.
  • Anthranilic acid derivatives (fenamates). Meclofenamic acid.

Selective COX-2 inhibitors include, but are not limited to, meloxicam, nimesulide, etodolac, and coxibs such as celecoxib.

Pharmacokinetics of NSAIDs

These types of drugs are rapidly absorbed by the body. They are mainly administered orally. However, they can also be used topically, intravenously and rectally. They reach their maximum concentration in the blood two or three hours after their absorption.

It is worth emphasizing that doctors recommend taking non-steroidal anti-inflammatory drugs with food. All because they can damage the mucosa that lines the intestines.

This type of drug has a high ability to bind to a plasma protein called albumin (95-99%). This is important because such a strong binding to albumin can cause interactions with other drugs that also have this trait.

NSAIDs  are metabolized in the liver and some of them have active waste products. Moreover, virtually all of them are characterized to some extent by enterohepatic circulation.

When they are metabolized, they are excreted by the kidneys. Therefore, doctors must be careful when prescribing them to patients with renal insufficiency and adjust the dose accordingly.

Side effects

Even after taking just one dose, all medicines can have side effects. For this reason, it is important to understand and understand the risks and benefits of taking a medicine before you start taking it.

Woman with stomach ache
The main side effects of taking NSAIDs are related to digestive problems. That is why patients should take them with food.

NSAIDs have gastrointestinal side effects. This may be an obstacle to the use of these anti-inflammatory painkillers. Besides, they are also poisonous to the kidneys. This means that they can cause kidney problems.

Other common side effects of these medications include:

  • Hypertension ,
  • Heart disease,
  • Rashes
  • Fluid retention.

Finally, we would like to emphasize that you should contact your doctor before deciding to start taking any NSAIDs. Knowing their side effects and taking them properly is the best way to achieve the therapeutic effect you want.

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