NSAID’s

Properties of NSAID’s

• Analgesic
• Antipyretic
• Anti-inflammatory

Note that anti-platelet is missing here with NSAID’s as opposed to salicylates.  There is a little bit of anti-platelet effect, not enough to be therapeutic, but you must know that it does because if a patient is going to have a procedure and they are on a non-steroidal, they must be stopped.  If they are on aspirin, they must be stopped 7 days ahead of time because of the mild anti-platelet activity.

Side effects

GI Effects: No surprise, just like the salicylates, there’s nausea and ulceration.  Ulcers are more common with NSAID’s than aspirin.

Sodium and water retention leads to hypertension and must be stopped if it does.

Decreased renal function: Notorious for causing damage to the kidneys and one of the leading causes of kidney failure.  When ibuprofen was being brought forward to the FDA to go OTC (it was originally by prescription only), the primary group of doctors that didn’t want it were the nephrologists because they knew it was going to cause an increase in kidney failures.  The only way to counteract this is by drinking lots of water.

Anti-platelet properties: Must discontinue prior to a procedure.

NSAID Drugs

When we treat patients for Rheumatoid Arthritis, there’s no science to it, it’s hit or miss, just like the anti-depressants, and they have to be on each drug for 2-3 weeks.

The drug list is huge.  Is there some commonality?  Some of these are in different families and you could seen -profen endings are in one family.  Endings in -ac are another commonality and unfortunately that’s about all we could differentiate.

• Indomethacin (Indocin) Probably one of the best NSAID’s but a lot of people can’t tolerate it because it gives people severe frontal headaches.
  
• Ketorolac (Toradol) – inj – This was our first analgesic injectable drug on the market that was a non-narcotic so it has no abuse potential.  This is a great option for addicts or drug seekers because there is no abuse potential.  A person cannot be on this drug for more than 5 days total because the risk of kidney damage goes up dramatically.  This is a problem with physicians that prescribe the medication for a few days when patients are in the hospital and write a new prescription for when they’re going home, making the total greater than 5 days.
• Sulindac (Clinoril) – Low incidence of kidney damage.  Not guaranteed absolutely safe but it’s relatively better.
• Ibuprofen (Motrin, Advil, Nuprin)
• Tolmetin (Tolectin)
• Naproxen (Naprosyn, Aleve)
• Diclofenac (Voltaren)
• Fenoprofen (Nalfon)
• Etodolac (Lodine)
• Piroxicam (Feldene)
• Ketoprofen (Orudis)          
• Meclofenamate (Meclomen)