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Clinician’s Corner: NSAIDS

We hear the term NSAIDS a lot in the pharmacy and in our doctor’s offices.  Just exactly what are they? Basically, they are drugs that block inflammation, like prednisone does but they are NOT steroids, like prednisone.  The name NSAID gives that away.

MOST NSAIDS inhibit COX-1 and COX-2 which are enzymes that produce prostaglandins that promote inflammation, pain, and fever; however, only COX-1 produces prostaglandins that activate platelets and protect the stomach and intestinal lining.

Here are the 4 A’s of blocking these enzymes

  • Anti-inflammatory (reduces inflammation)
  • Antipyretic effect (reduces fever)
  • Antithrombotic effect (reduces platelet stroke risk)
  • Analgesic effects (reduces pain)

PRECAUTIONS for NSAIDs:

  • KIDNEY: Caution if kidney dysfunction. They block blood flow to the kidneysWe will devote an entire column to renal effects of NSAIDS
  • PREGNANCY: Bottom line, avoid if pregnant. Use lowest effective dose, intermittently if possible, especially in late pregnancy (avoid during last eight weeks of pregnancy).
    • First Trimester: link to miscarriage and certain rare birth defects in the first trimester
  • NURSING MOMS: Because of its extremely low levels in breastmilk, short half-life and safe use in infants in doses much higher than those excreted in breastmilk, ibuprofen is a preferred choice for pain or anti-inflammatory agent in nursing mothers. Best to avoid Naproxen (Aleve®)  http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
  • STOMACH: active stomach or bowel disease
  • LIVER: Caution in liver impairment.
  • HEART: Makes heart failure worse, as well as increased risk of heart attack, stroke, and death. If an NSAID is needed Naproxen is a safer choice.
  • EVERYTHING ELSE:
    • Photosensitivity- increase chance of sunburn
    • Avoid Aspirin & alcohol while taking NSAID
    • Watch for increased blood pressure

PREVENTION OF GASTROINTESTINAL RISKS:

  • Proton pump inhibitors, line Prilosec, Nexium, Protonix, Prevacie
  • High dose Pepcid (famotidine) 40mg twice daily, will reduce risk of both gastric and duodenal ulcers

When we see the potential harms that NSAIDs cause our patients, we encourage all our patients to seek advice from your Thompson Pharmacist.  Go ahead and ask, at Thompson Pharmacy it’s ALL for YOU!!