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.
Abduieva FM, Bychkova OYu, Bondarenko IO, Burda IYu, Vlasenko OO, Yehorova AYu, et al. Clinical pharmacology: Textbook for students and doctors. Gen. ed. Yabluchanskyi MI, Savchenko VM. Kharkiv: V.N. Karazin Kharkiv National University; 2011. 405 p. [In Ukrainian].
Haley RM, Recum HA. Localized and targeted delivery of NSAIDs for treatment of inflammation: A review. Experimental Biology and Medicine. 2019;244:433-44. DOI: 10.1177/1535370218787770. PMID: 29996674.
Kadusevicius E. Novel applications of NSAIDs: insight and future perspectives in cardiovascular, neurodegenerative, diabetes and cancer disease therapy. Int. J. Mol. Sci. 2021;22:6637. DOI: 10.3390/ijms22126637. PMID: 34205719.
Clinical pharmacology and pharmacotherapy in rheumatology. Krasko MP, Kraidashenko OV, Kremzer OO, Krasko VV. 2nd ed., rev. and add. Zaporizhzhia; 2015. 317 p. [In Ukrainian].
R van Rensburg, Reuter H. An overview of analgesics: NSAIDs, paracetamol, and topical analgesics Part 1. South African Family Practice. 2019;61:sup1:4-10. DOI: 10.1080/20786190.2019.1610228.
Wheatley BM, Nappo KE, Christensen DL, Holman AM, Brooks DI, Potter BK. Effect of NSAIDs on bone healing rates: a meta-analysis. Journal of the American Academy of Orthopaedic Surgeons. 2019;27(7):330-6. DOI: 10.5435/JAAOS-D-17-00727. PMID: 30260913.
Compendium 2019 – medicinal products. Kyiv: Morion; 2019. 2870 p. Available at: https://compendium.com.ua/uk/handbooks-uk/compendium-uk/ [in Ukrainian].
Smith D, Wilkie R, Croft P, Parmar S, McBeth J. Pain and mortality: mechanisms for a relationship. Pain. 2018;159(6):1112-8. DOI: 10.1097/j.pain.0000000000001193. PMID: 29570110.
Pelletier R, Bourbonnais D, Higgins J, Mireault M, Harris PG, Danino MA. Pain interference may be an important link between pain severity, impairment, and self-reported disability in participants with wrist/hand pain. J Hand Ther. 2020;33(4):562-70.e1. DOI: 10.1016/j.jht.2019.06.001. PMID: 31481341.
Enthoven WTM, Roelofs PD, Koes BW. NSAIDs for chronic low back pain. JAMA. 2017;317(22):2327-8. DOI: 10.1001/jama.2017.4571. PMID: 28609520.
McMahon SB, Dargan P, Lanas A, Wiffen P. The burden of musculoskeletal pain and the role of topical non-steroidal anti-inflammatory drugs (NSAIDs) in its treatment. Ten underpinning statements from a global pain faculty. Current Medical Research and Opinion. 2021;37(2):287-92. DOI: 10.1080/03007995.2020.1847718. PMID: 33155849.
McHugh CG, Opare-Addo MB, Collins JE, Jones MH, Selzer F, Losina E, Katza JN. Treatment of the syndrome of knee pain and meniscal tear in middle-aged and older persons: A narrative review. Osteoarthr Cartil Open. 2022;4(3):100282. DOI: 10.1016/j.ocarto.2022.100282. PMID: 35991623.
Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019;27(11):1578-89. DOI: 10.1016/j.joca.2019.06.011. PMID: 31278997.
Ho KY, Cardosa MS, Chaiamnuay S, Hidayat R, Ho HQT, Kamil O, et al. Practice advisory on the appropriate use of NSAIDs in primary care. Journal of Pain Research. 2020;13:1925-39. DOI: 10.2147/JPR.S247781. PMID: 32821151.
Domper Arnal M-J, Hijos-Mallada G, Lanas A. Gastrointestinal and cardiovascular adverse events associated with NSAIDs. Expert Opinion on Drug Safety. 2022;21(3):373-84. DOI:10.1080/14740338.2021.1965988. PMID: 34376069.
Moore N. Coronary risks associated with diclofenac and other NSAIDs: an update. Drug Saf. 2020;43(4):301-18. DOI:10.1007/s40264-019-00900-8. PMID: 31916080.
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