Medication Names:
Cox 1/2 Selective
Inhibitors:
Choline Magnesium Salicylate (Trilisate®)
Diclofenate Potassium (Cataflam)
Diclofenate Sodium (Votarin®)
Diflunisal (Dolobid®)
Fenaprofen (Nalfon®)
Etodolac (Lodine®)
Flubiprofen (Ansaid®)
Ibuprofen (Motrin®, Advil®Nuprin®)
Indomethacin (Indocin®)
Ketorolac (Toradol®)
Ketoprofen(Orudus®, Oruvail®)
Meclofenamate (Meclomen®, Ponstil®)
Meloxicam (Mobic®)
Nabumatome (Relafen®)
Naproxen (Naprosyn®)
Naproxen Sodium (Anaprox®)
Oxyprozin (Daypro®)
Piroxicam (Feldene®)
Salsalate, (Disalcid®)
Sulindac (Clinoril®)
Tolmetin (Tolectin®)
On Label Use:
Non Steroidal Antiinflammatories are used for the treatment of Inflammatory Arthritis.
Pain Use:
Treatment of acute and chronic inflammatory pain
Treatment of acute and chronic non-inflammatory pain as early rung of the the WHO analgesic ladder. It appears to work on decending modifying pathways from the brain to the spinal cord.
Synergy with Opioid analgesics
Therapeutic Benefit:
Decrease in acute and chronic pain levels
Decrease in inflammation and prevention of chronic inflammation
Prevention of Sympathetic coupling secondary to chronic inflammation
Adding a Non steroidal to an opioid is often more effective than doubling the opioid. Adding an opioid to a Non steroidal is often more effective than doubling the Non steroidal
Platelet inhibition can provide cardioprotective effects
Dose Range:
Varies for different medications
Titration:
This medication should be taken with food to prevent gastic irritation, reflux. Food does not prevent ulceration. Use of concommitant proton pump inhibitors may help prevent ulceration, but may not. There is no evidence that Misoprostol or Sucralfate help in healing ulcers, but H2 blockers and proton pump inhibitors may help.
Side Effects:
GI discomfort, dyspepsia, dizziness, drowsiness are frequent side effects
Ulceration is very common and as high as 30% in some studies of intermediate to long term use. Ulcers can occur any time during treatment and may not be symptomatic.
GI bleeds are also common side effects. In several prospective and retrospective studies of GI bleed admissions to university hospital GI services up to 80% of admission with active GI bleeds were Cox 1/2 NSAID related. Many bleeds are not caused by ulcers, which means prevention of ulcers does not necessarily prevent GI bleeds. Bleeds occur in 1/10000 months of NSAID use
GI perforations are a serious complication. This risk increases 10 fold with smoking and alcohol.
A high percentage of esophagitis patients use NSAIDs with Aspirin being the biggest culprit.
Liver enzymes can be elevated
Nephritis can occur
Platelet inhibition occurs and Aspirin causes the longest inhibition for the full 7 days of platelet life.
Drug Interactions:
Drug interactions vary. Displacement of Coumadin from protein binding sites may increase the INR for patients on Coumadin. Antacids decrease NSAID absorption. NSAIDs may reduce effectiveness of diuretics. Serum Lithium levels are increased by NSAIDs
Dependency or Abstinence Syndrome:
None
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