● Naproxen (Naprosyn, Aleve) : Naproxen availability is 41% higher in women than in men and is effective for rheumatologic conditions in a slow-release formula, as a topical preparation, and as an eye- wash. Over- the-counter use of naproxen is associated with two times greater incidence of gastrointestinal bleeding than that of over-the-counter use of ibuprofen. Beyond normal NSAID-associated effects, rare cases of allergic pneumonitis, leukocytoclastic vasculitis, and pseudopophyria are associated with use. ● Oxaprozin (Daypro) : The major difference between this drug and other NSAIDs like it is its very long half-life, permitting dosage in a once-a-day formulation (Farinde, 2023). Fenamate NSAIDs Meclofenamate sodium and mefenamic acid (Ponstel) inhibit both COX and phospholipase A2. Meclofenamate has similar side effects to other NSAIDS, with slightly higher incidence of abdominal pain and diarrhea. It also enhances the effect of oral anticoagulants and is contraindicated in pregnancy. Mefanamic acid is less effective than aspirin as an anti- inflammatory but is considerably more toxic. It should not be used for a period over one week (Farinde, 2023). Oxicam NSAIDs Piroxicam (Feldene): Has a long half-life, permitting once- a-day dosage. At high concentrations, this COX inhibitor also inhibits leukocyte migration, decreases oxygen radical production and inhibits lymphocyte function. Toxicity includes gastrointestinal symptoms in 20 percent of users, and other adverse effects including headache, dizziness, tinnitus, and rash. Peptic ulcer and bleeding can occur at higher dosages, at a rate more than nine times that of other NSAIDs. Salicylates NSAIDS ● Diflunisal (Dolobid) : Although it is derived from salicylic acid, it is not reduced to salicylic acid or salicylate. Clearance is dependent on renal function and hepatic metabolism, and dosages should be limited in users with renal impairment. It is considered particularly effective for pain in cases of bone metastases and dental surgery. Aspirin (acetylsalicylic acid, ASA Bayer ® ) Commonly known as aspirin , acetylsalicylic acid is this country’s most widely used drug, both singularly and in combination with many prescription and patent medicines. Used for many different aches and pains, aspirin can injure Contraindications of aspirin ● Allergy : Aspirin is contraindicated in people with known allergy to nonsteroidal anti-inflammatory drug products and in patients with the syndrome of asthma, rhinitis, and nasal polyps. Aspirin may cause severe urticaria, angioedema, or bronchospasm (asthma). ● Reye’s syndrome : Aspirin should not be used in children or teenagers for viral infections, with or without fever, because of the risk of Reye’s syndrome with concomitant use of aspirin in certain viral illnesses. ● Alcohol warning : People who consume three or more alcoholic drinks every day should be counseled by their doctor about the bleeding risks involved with chronic, heavy alcohol use while taking aspirin. ● Coagulation abnormalities : Even low doses of aspirin can inhibit platelet function, leading to an increase in bleeding time. This can adversely affect people with inherited (hemophilia) or acquired (liver disease or vitamin K deficiency) bleeding disorders.
NSAID side effects in general include (Eustice, 2022): ○ Gastrointestinal : Dyspepsia, heartburn, epigastric distress, and nausea; less frequently, vomiting, anorexia, abdominal pain, GI bleeding, and mucosal lesions. Misoprostol (Cytotec), a synthetic prostaglandin that inhibits gastric acid secretion, may be given to prevent GI intolerance. It prevents gastric ulcers and their associated GI bleeding in people receiving NSAIDs. ○ Genitourinary : Fluid retention, reduction in creatinine clearance, and acute tubular necrosis with renal failure ○ Hepatic : Acute reversible hepatotoxicity ○ Cardiovascular : Hypertension and moderate to severe noncardiogenic pulmonary edema ○ Hematologic : Altered hemostasis through effects on platelet function ○ Other : Skin eruption, sensitivity reactions, tinnitus, and hearing loss In most cases, the choice of an NSAID is based on risk of toxicity and cost-effectiveness. In general, the gastrointestinal and renal side effects of ketorolac limit its use. On a toxicity index, indomethacin and meclofenamate were associated with the greatest toxicity, while salsalate, aspirin, and ibuprofen were least toxic of all the non- selective COX inhibitors. For users with renal dysfunction, nonacetylated salicylates may have fewer side effects. Fenoprofen is used less because it is associated with interstitial nephritis. Two nonselective NSAIDs, diclofenac and sulindac, are more associated with liver function abnormalities than any other NSAIDs. In most cases, physicians seek a good fit between an individual’s needs and sensitivities and an NSAID that best suits those needs. All nonacetylated salicylates are useful anti-inflammatories, although they may be less effective analgesics than aspirin. There are significantly less effective than aspirin as cyclooxygenase inhibitors, so are more desirable when cyclooxygenase inhibition is not wanted, which is the case in individuals with asthma, bleeding tendencies, and renal dysfunction. Individuals taking nonacetylated salicylates should be monitored for serum salicylate levels (Eustice, 2022). the stomach, interfere with the absorption of several vitamins (especially C, K, and folic acid), and pose a special risk for pregnant women and patients with ulcers (Arif & Aggarwal, 2023). ● Gastrointestinal side effects : GI side effects include stomach pain, heartburn, nausea, vomiting, and gross GI bleeding. Although minor upper GI symptoms, such as dyspepsia, are common and can occur anytime during therapy, physicians should remain alert for signs of ulceration and bleeding, even in the absence of previous GI symptoms. Physicians should inform patients about the signs and symptoms of GI side effects and what steps to take if they occur. ● Peptic ulcer disease : People with a history of active peptic ulcer disease should avoid using aspirin, which can cause gastric mucosal irritation and bleeding. ● Renal failure : Avoid aspirin in people with severe renal failure (glomerular filtration rate less than 10 mL/minute). ● Hepatic insufficiency : Avoid aspirin in people with severe hepatic insufficiency.
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