PEBC: What You Need to Know: Non-Steroidal Anti-Inflammatory Drugs

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) inhibit COX-1 and COX-2 enzymes involved with inflammation. There are many agents including naproxen, ibuprofen, acetylsalicylic acid, meloxicam, indomethacin, celecoxib (COX-2 selective) and more!

Dosing varies with each agent, but these must be taken with food to reduce stomach irritation and bleed risk.

Adverse Effects: Many!

1. Gastric Irritation: lowest risk is with COX-2 selective NSAIDs (diclofenac and celecoxib). Choose enteric coated versions, or use proton pump inhibitors for high risk patients or long-term NSAID use.

2. Cardiovascular: Increased events such as hypertension and myocardial infaction (especially celecoxib)

3. Renal: Altered renal perfusion, leading to kidney dysfunction and impairment

-Caution in pregnancy due to malformations and interference with closure of ductus arteriosus

-May exacerbate heart failure through fluid retention

Drug Interactions:

-Antihypertensives: loss of effect

-Blood thinners, SSRIs: increased risk of bleed

-Lithium: leads to increased lithium levels