Non-steroidal anti-inflammatory drug

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Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAIDs, are drugs with analgesic, antipyretic and anti-inflammatory effects: they reduce pain, fever and inflammation. They act by inhibiting cyclooxygenase enzymes, which form prostaglandins from arachidonic acid.

Most known NSAIDs act as non-selective inhibitors of cyclooxygenase - they inhibit both the cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) isoenzymes. Examples of NSAIDs include the salicylates (including aspirin), diclofenac, indomethacin, ibuprofen, ketoprofen, naproxen, meloxicam and piroxicam. COX-1 is also found in the stomach lining, but the prostaglandins here serve a protective role, preventing the stomach mucosa from being eroded by its own acid. When COX-1 inhibitors lower stomach prostaglandin levels, their protective effects are lost, and stomach ulcers and internal bleeding can result.

Paracetamol (acetaminophen), owing to its cyclooxygenase inhibition, is sometimes grouped together with the NSAIDs. Paracetamol, however, does not have any significant anti-inflammatory properties and is not a true NSAID.

Newer NSAIDs such as celecoxib, rofecoxib, valdecoxib, parecoxib and etoricoxib; are more selective inhibitors of COX-2. While it was hoped that this COX-2 selectivity would reduce gastrointestinal adverse drug reactions (ADRs) there is little conclusive evidence that this is true. The original study touted by Pharmacia (now part of Pfizer), showing a reduced rate of ADRs for celecoxib, was later revealed to be based on preliminary data - the final data showed no significant difference in ADRs when compared with diclofenac. Rofecoxib, however, has been shown to produce significantly fewer gastrointestinal ADRs compared to naproxen. The same study raised an as yet unresolved question regarding the cardiovascular safety of the coxibs - a statistically insignificant increase in the incidence of myocardial infarcts was observed in patients on rofecoxib. Further studies are currently underway to resolve these questions.