What are NSAIDs ?
NSAIDs (short for non-steroidal anti-inflammatory drugs, nonsteroidal anti-inflammatory drugs) are anti-inflammatory drugs that do not belong to the group of corticosteroids. Another word for this is NSAIDs.
Examples of NSAIDs are ibuprofen, diclofenac, meloxicam, naproxen, etofenamate, celecoxib. The acetylsalicylic acid (aspirin, Aspegic) is also among the NSAIDs. This substance there was already a century before the actual NSAIDs have been developed and, moreover, has a different native effect on blood coagulation.
Effects of an NSAID
In addition to inflammation inhibition many NSAIDs also have an analgesic and fever-lowering effect. They are often used in cases of acute pain (for example, an injury) or chronic joint pain (rheumatism) and attacks of gout. In the third trimester of pregnancy, NSAIDs an inhibitory effect on the contractions.
Operation and maintenance of a NSAID
NSAIDs are drugs that inhibit by means of inhibition of the cyclo-oxygenase-protein (COX) the formation of prostaglandins in the body. Prostaglandins stimulate the perception of pain, increase body temperature (fever) and cause blood vessels stand open (redness of inflammation). Most of the NSAIDs inhibit both the protein COX-1 and COX-2.
Prostaglandins are involved in the construction of the gastric mucosa. Since NSAIDs inhibit the formation of prostaglandins, the gastric mucosa becomes increasingly thinner and may become easily irritated by the stomach acid. NSAIDs should therefore be treated with caution, especially in people who easily get stomach problems and people who may suffer serious consequences from a stomach hemorrhage (eg by use of anticoagulants). In particular, COX-1 seems to be associated with the development of stomach complaints.
Some NSAIDs have a blood coagulation time extending action. As a result, they do not promote the cure of any disease of the stomach. Sometimes it is for this reason a stomach protector, for example, omeprazole or pantoprazole, used when people for long periods of time (chronic) NSAID use.
NSAIDs also have an effect on the kidney. Because they have an inhibitory effect on the synthesis of prostaglandins, the effect of these prostaglandins on the sieve cells in the kidney (opening of the blood afferent (afferent) arteriole) counteracted. This results in a reduction of the blood flow in the kidney, so that it detects the circulating volume is too small and will retain moisture and salt. This can lead to high blood pressure.
The combination of an NSAID with an ACE inhibitor is not recommended because this may increase the adverse effects of NSAIDs on renal perfusion. The NSAID leads, as above reported, to constriction of the afferent arteriole, whereby the filtration pressure drops. This decrease in filtration pressure can compensate for renal vasoconstriction of the draining (efferent) arterial, but can simultaneously administered an ACE inhibitor (angiotensin II-dependent) efferent vasoconstriction not longer take place, which can lead to kidney failure. The filtration pressure can then drop to low levels, causing renal failure occurs. The use in women who are pregnant, are pregnant or breastfeeding are strongly discouraged.
In some people, NSAIDs cause a dry cough by bronchospasm. Asthmatics may get a severe attack after use of NSAIDs.
Hospital admissions by NSAIDs and aspirin.
NSAIDs and acetylsalicylic acid (eg aspirin), according to the report Harm Wrestling responsible for 50% of preventable acute hospital admissions in the Netherlands. In the Netherlands, 20% of the population swallows NSAIDs or acetylsalicylic acid, so that this group is over-represented. On 26 March 2008 the Minister of Health sent the report to the Dutch parliament. Meanwhile, both chambers of the States General has accepted the report. Moreover, going ibuprofen concurrently with aspirin platelet inhibitory effect of aspirin against and will thus reduce the cardioprotective effects of aspirin. After a major series of lawsuits against the classification by the CBG appeared in October 2012 which was maintained the proposed classification in the Netherlands. Ibuprofen 200mg is in free sale. Some NSAIDs at the drugstore and an even larger proportion in larger containers, the status UA (Pharmacy Only). Also remains a group of UR (Prescription Only). Recommendation 20 of the report Harm-Wrestling was ignored so.
Selective COX-2 inhibitor
Recently, there has developed a class of drugs, the COX-2 inhibitors that period would have the advantages of the other NSAIDs, but fewer side effects. Examples are rofecoxib (Vioxx), celecoxib or ®. Nevertheless, it has been found that these agents also have not been completely risk-free. The drug Vioxx was taken off the market after a few years in September 2004 in controversial manner by the manufacturer because it was found to increase the risk of heart attack.