More Facts About NSAIDs
Since NSAIDs bind to plasma proteins they may be displaced by or may displace other plasma-bound drugs such as coumadin, methotrexate, digoxin, cyclosporine, oral antidiabetic agents, and sulfa drugs. This interaction can enhance either therapeutic or toxic effects of either drug.Due to their different chemical properties some NSAIDs have substantial biliary (bile ducts, gallbladder) excretion (i.e. indomethacin , sulindac) and others are metabolized pre-excretion, while a few are excreted in the urine unchanged.NSAID studies which have shown a variation in patient response attribute a lower rate of adherence to one NSAID when other NSAIDs are known to be available. The response to and preference of an NSAID may relate to more than just symptom control.
About 60% of patients will respond to any single NSAID. A trial period of three weeks should be given for anti-inflammatory effectiveness to be observed. About 10% of rheumatoid arthritis patients will not respond to any NSAID.Antipyretic and anti-inflammatory effects of NSAIDs can mask the signs and symptoms of infection.Adverse effects of NSAIDs which can occur at any time include renal (kidney) failure, hepatic (liver) dysfunction, bleeding, and gastric (stomach) ulceration.NSAIDs (particularly indomethacin) can interfere with the pharmacologic control of hypertension and cardiac failure in patients who take beta-adrenergic antagonists, angiotensin-converting enzyme inhibitors, or diuretics.Long-term use of NSAIDs may have a damaging effect on chondrocyte (cartilage) function.
Which NSAID Is Best?
It can not be predicted which NSAID will best serve a particular patient. No single NSAID has been proven to be superior over the others for pain relief. Once an NSAID is selected, the dosage should be increased until pain is relieved or until the maximum tolerated dose has been reached. The duration of analgesia does not always correspond with the plasma half-life of the NSAID. The patient response should be a guideline for selecting the proper dose, using the lowest dose possible to obtain pain relief.
Related Resources
NSAIDs / Nonsteroidal Anti-Inflammatory Drugs
COX-2 Selective Inhibitors
Salicylates
Over-The-Counter Drugs
Arthritis Medications
Sources: The Duke University Medical Center Book of Arthritis, David S. Pisetsky, M.D., Ph.D.;New England Journal of Medicine, 324(24):1716-1725, 1991
