GENERAL
Non steroid anti-inflammatory drugs (NSAID”S), such as aspirin and paracetamol, are the most commonly used drugs for the treatment of chronic pain syndromes. Unlike paracetamol, NSAID”S and aspirin have anti-inflammatory properties. As opposed to opioids, these drugs present the ceiling phaenomenon. This means that after administering a specific dose for each drug, the additional administered dose provides no further analgesia. NSAID”S and aspirin may cause gastrointestinal complications, such as gastritis, stomach or intestinal ulcer and haemorrhage, whereas paracetamol in high doses may induce hepatotoxicity.
Patients with liver and kidney diseases and alchoholics are in higher risk for complications even with low doses of the above drugs. Regular use of anti-inflammatory drugs seem to increase blood hypertension risk. Other complications that might occur with chronic use of NSAID”S are cardiovascular and kidney adverse events (analgesic- induced nephropathy).
Patients who already take aspirin for its anti-platelet and cardioprotective action and are to use anti-inflammatory drugs, should first consult their cardiologist because co-administration reduces the aspirin’s heart protective action. Co-administration of paracetamol and anti-inflammatory drugs for a long period of time may cause serious complications in the renal function and therefore should be avoided.
There are two groups of anti-inflammatory drugs: cyclooxygenase inhibitors I (COX-1) and cyclooxygenase inhibitors II (COX-II). There are anti-inflammatory drugs inhibiting COX-I and COX-II, such as nimesulide, diclofenac, meloxicam, naproxen and others. Coxibes are selective COX-II inhibitors. COX-II inhibitors are anti-inflammatory drugs with lower risk for gastrointestinal complications when taken for less than six months. The risk for complications increases as the dosage increases and as their use is prolonged.
INDICATIONS FOR NSAID”S
• Pain due to acute inflammation
• Arthritis
• Headache
• Μyalgia
• Mild to moderate pain of non-inflammatory aetiology
• Cancer pain
α) bone metastasis
β) soft tissue pain due to compression or expansion of tissues
γ) vicsceral pain due to peritoneal or pleural irritation
CONTRAINDICATIONS FOR NSAID”S
• acute peptic ulcer
• Oesophagitis
• Coagulation disorders
• Full-term gestation
USEFUL GUIDE FOR NSAID”S
1. ANTI-INFLAMMATORY DRUGS MAY INCREASE THE CHANCE FOR HEART ATTACK THAT CAN EVEN LEAD TO DEATH
High risk increases with:
• prolonged administration
• in patients with heart disease
2. ANTI-INFLAMMATORY DRUGS SHOULD NOT BE USED IN THE FOLLOWING CASES:
• immediately before or after aortocoronary bypass
• during an episode of bronchial asthma
3. ANTI-INFLAMMATORY DRUGS MAY CAUSE STOMACK OR/AND INTESTINAL ULCER AND HAEMORRHAGE ANY TIME DURING THE THERAPY
Ulcer and haemorrhage may:
• occur without any warning
• cause death
4. HAEMORRHAGE OR ULCER RISK INCREASES WITH:
• Simultaneous administration of corticosteroids and anticoagulants
• Long term administration
• Smoking
• Alchohol intake
• Andanced age
• Poor health condition
5. ANTI-INFLAMMATORY DRUGS SHOULD BE USED ONLY:
• strictly with medical prescritpion
• in the lowest effective dosage
• for the shortest period of time possible
CATEGORIES OF NSADs
ACETIC ACID DERIVATIVES
1. Diclofenac (voltaren)
2. Aceclofenac (biofenac)
3. Indomethacin (reumacid)
PROPIONIC ACID DERIVATIVES
1. Ιbuprofen (advil, brufen, algofren,nurofen)
2. Naproxen (naprosyn)
3. Ketoprofen (oruvail)
ANTHRANILIC ACID DERIVATIVES (PHENAMATES)
1. Etofenamate (roiplon)
2. Μephenamic acid (ponstan)
OXICAMES
1. Lornoxicam (xefo,xefo rapid)
2. Meloxicam (movatec, loxitan)
3. Pyroxicam (feldene,brexin)
4. Tenoxicam (tilcitin)
COXIBES
1. Etericoxib (arcoxia)
2. Selecoxib (celebrex)
3. Parcoxib (dynastat) [only in injectable form]
ΑΛΛΑ ΜΗ ΣΤΕΡΟΕΙΔΗ ΑΝΤΙΦΛΕΓΜΟΝΩΔΗ
1. Νimesulide (mesulid)
PARACETAMOL
The maximum daily dose should not exceed 4 gr due the risk of acute liver failure.
It can be co-administered with other groups of drugs to improve the analgesic outcome. It has no inti-inflammatory properties.
1. Apotel
2. Depon
3. Panadol
4. Lonarid plain
5. Spasmo-apotel
6. panadol – extra
7. apotel extra
SALICYLIC ACID DERIVATIVES
Acetylsalicylic acid
1. Aspirin
2. Salospir
3. Upsalgin
