Written By: Abier Hamami. RPH. CPHQWhat are NSAIDs?
Nonsteroidal Anti-inflammatory Drugs (NSAIDs) are commonly prescribed medications for the inflammation of arthritis and other body tissues, such as in tendinitis and bursitis. Examples of traditional NSAIDs include Aspirin, Indomethacin, Ibuprofen, Naproxen, Piroxicam, and Diclofenac.

How do NSAIDs work?

NSAIDs block the release of Prostaglandins which are chemicals produced within the body's cells by the enzyme Cyclooxygenase (Cox). Prostaglandins have several important functions:

Promote inflammation, pain, and fever.Support the function of platelets that are necessary for the clotting of blood.Protect the lining of the stomach from the damaging effects of acid.

What are COX-2 inhibitors?

Cox-2 inhibitors are a new class of (NSAIDs). They selectively block Cyclooxegenaze-2( COX-2), so inhibit the production of prostaglandins that cause the pain and swelling of arthritis inflammation. Examples include Celecoxib (Celebrex®), Rofecoxib(Vioxx® ,no longer on market as of September 2004), and Valdecoxib (Bextra®, no longer on market as of April 2005).

How do traditional NSAIDs differ from new COX-2 inhibitors?
COX-1 enzyme is normally present in a variety of areas of the body, including sites of inflammation and the stomach. While COX-2 enzyme, is located specifically in areas of the body that are responsible for inflammation and not in the stomach.

Traditional NSAIDs block the function of COX-1 enzyme which means beside reducing inflammation, they also reduce the protective mucus lining of the stomach causing stomach upset, ulceration, and bleeding. On the other hand, new COX-2 inhibitors block the function of COX-2, thus reduces inflammation, but do not affect the stomach and intestines compared to the traditional NSAIDs

How should you take a NSAID?
You should take a traditional NSAID with food, and do not lie down for 15 to 30 minutes after taking it, whereas, COX-2 inhibitors could be taken with or without food.

What are the side effects of NSAIDs?
The most common side effects of traditional NSAIDs are abdominal pain, diarrhea, bloating, heartburn, water retention, and upset stomach (dyspepsia). Approximately 15% of patients on long- term NSAID treatment develop ulceration of the stomach and duodenum.

Notify your doctor if you notice any black or bloody stools, chronic indigestion or heartburn, or vomiting of blood or “coffee ground” like material.

COX-2 inhibitors are linked to serious side effects as blood clots, stroke, and heart attacks; other less serious side effects include heart burn, stomach pain and upset, headache, and swelling of the legs/feet.

What factors can increase the risk of NSAIDs use?
For traditional NSAIDs, risk factors include high blood pressure, asthma, a history of kidney or liver disease, past ulcers, and people over age 65.

For COX-2 inhibitors, risk factors include also heart attack, stroke, angina, blood clot or hypertension.

What about taking NSAIDs with other medications?
NSAIDs may intensify or counteract the effects of some medications. Therefore, it is very important that your doctor knows if you are taking any other medicine. This includes prescription and non–prescription medicines as well as birth control pills, Vitamins, and herbal supplements. In general NSAIDS can be taken with other medications, but should not be taken with other blood thinners such as Heparin, or other Anti–Coagulants. Please inform your doctor if you are taking any of these types of medicines.

If you are taking a COX-2 inhibitor, you should not use a traditional NSAID (prescription or over-the-counter). Also be sure to tell your doctor if you are sensitive to Aspirin, Sulfa drugs, or other NSAIDs.

References:

Arthritis Foundation
John Hopkins Arthritis Center
American Academy of Orthopaedic Surgeons
http://www.medicinenet.com/cox-2_inhibitors/articlehtm
http://www.medicinenet.com/nonsteroidal_antiinflammatory_drugs/article.htm