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Clinician’s Corner: Non-steroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs (NSAIDs are frequently dispensed in our pharmacy. We’ve had them for many years and new information about when NOT to use them seems to come out rather frequently. With all the pressure on prescribers to avoid opioids, NSAIDs are being called upon to provide pain relief for our patients.  Even though a couple of these drugs (ibuprofen, naproxen and ketoprofen) have over-the counter status, these drugs can cause problems . There are at least 16 NSAIDS with different effects and side effects.

The first and still most famous NSAID, aspirin was developed by the Bayer Company in Germany in 1899, one year after Heroin® (diacetyl morphine) was introduced.

The earliest NSAID came from white willow bark and contained salicin, similar to aspirin (acetylsalicylic acid). Our local aspen and birch trees also have salicin in their bark.  Salicin was a precursor to aspirin before its development and was used for reducing pain and inflammation. Hippocrates, the Greek physician (460 to 377 B.C.), wrote that willow leaves and bark relieved pain.

Edward Stone, rediscovered aspirin in 1767, in effect, when he wrote that powdered willow bark seemed to benefit 50 patients with malaria. The next big advance for non-steroidal anti-inflammatory drugs came when Felix Hoffman and Arthur Eichengrun formulated aspirin. This compound was later marketed by Bayer under the trade name Aspirin which was registered as a trade name in 1899.

Mechanism: inhibits synthesis of inflammation producing hormones in our body. Aspirin inhibits platelets and keeps them from forming clots.  Today most patients use aspirin for cardiovascular protection, which will be covered later.

AVOID: aspirin in kids under 18, due to the risk of Reye’s syndrome. Reye’s syndrome is a rare but serious condition that results in fatty changes of the liver and acute brain swelling mostly in children and teenagers recovering from a viral illness such as influenza or chickenpox.

The persistent vomiting seen with Reye’s syndrome can result in dehydration and electrolyte abnormalities, especially in young children. Left untreated, patients can experience minor brain damage, seizures and possibly death. Also avoid other forms of salicylates such as Pepto-Bismol, menstrual products with magnesium salicylate and Alka-Seltzer.

With the upcoming flu season, it is always a good idea to consult your Thompson Pharmacist before taking anything if you get the flu.  The best way to prevent the flu is getting your flu shot!  Now is the best time to protect yourself from the flu, by asking your Thompson Pharmacist to give you a flu shot.  Go Ahead and ASK… at Thompson Pharmacy it’s all for YOU!