Desired Effect

• Anti-pyretic, analgesic, anti-inflammatory effects.
• Non-selective (COX1 & COX2 inhibitors): Aspirin (analgesic), diclofenac, ibuprofen.
• Selective NSAIDs (COX2 inhibitors): Celecoxib, meloxicam

MOA

• The enzymes that transform arachidonic acid into prostaglandins (+ prostacyclins/ thromboxanes) are called cyclooxygenases (COX). There are two types (isoforms) of COX enzymes, COX-1 and COX-2.
• NSAIDs inhibit COX‑1 and COX‑2 to inhibit the production of prostaglandins:
  • Inhibition of COX‑1 results in impaired gastric cytoprotection and antiplatelet effects.
  • Inhibition of COX‑2 results in anti-inflammatory and analgesic action.

Indication

• Fever
• Mild/moderate/severe pain.
  • Pain due to inflammatory arthropathies. i.e. rheumatoid arthritis, osteoarthritis, juvenile idiopathic arthritis, gout, ankylosing spondylitis.
  • Pain, especially due to inflammation and tissue injury (i.e. dysmenorrhoea, pericarditis, bone metastases, renal colic, headache, migraine, postoperative pain).

Contraindication/precaution

Precautions:

• Dehydration (NSAIDs reduce renal function à AKI).
• Asthma (NSAIDs may increase risk of bronchospasm).
• Coagulation disorders (NSAIDs have an anti-platelet effect).
• Cardiovascular/cerebrovascular disease.