SOME CONTEMPORARY VIEWS ON NON-STEROIDAL ANTI-INFLAMMATORY DRUGS

Background . Non-steroidal anti-inflammatory drugs (NSAID) are important for the treatment of inflammation and pain. In equal doses these drugs provide more or less equal effects. As a result of the prostaglandin inhibition they cause gastrointestinal adverse effects, disturbances of kidney function and blood coagulation. Clinically significant are their gastrointestinal adverse effects, manifested as perforations, ulcerations and hemorrhages. Non-steroidal anti-inflammatory drugs differ in their potency of inhibition of two cyclooxygenase isoforms. Their adverse effects are primarily due to the inhibition of constitutive cyclooxygenase 1. Consequently, the treatment of choice is a less harmful nonsteroidal anti-inflammatory drug, which is a less potent inhibitor of cyclooxygenase 1. The newer drugs of the class of coxibs have a less potent effect on the gastrointestinal prostaglandins, so they cause fewer gastrointestinal adverse effects, however they inhibit the constitutive cyclooxygenase 2 in the kidneys. In this way they reduce prostaglandin synthesis and blood flow in the kidneys. Contraindications for their use are similar to those characteristic of conventional nonsteroidal anti-inflammatory drugs, especially heart and kidney failure, gastrointestinal ulcerations and bleeding, and inflammatory bowel disease. An additional new indication has been established for these drugs – treatment of familial adenomatous polyposis. Conclusions . The conventional nonsteroidal anti-inflammatory agents are relatively safe drugs when used in lower doses and for the shortest possible time. Safe use of these drugs is based on correct intake, careful selection of patients and protection of patients who present with risk factors for gastrointestinal adverse effects.