Non-steroidal anti-inflammatory drugs

NSAIDs block the cyclooxygenase enzymes COX-1 and COX-2, which turn arachidonic acid into prostaglandins and thromboxane. With less prostaglandin, nerve endings are less sensitized, inflammation settles and fever falls. Losing COX-1 products in the stomach and platelets, and the prostaglandins that keep blood flowing through the kidney, explains their ulcers, bleeding and kidney harm.

• IbuprofenShort-acting, with a half-life of about 2 hours; sold without a prescription for pain and fever, and also made as a gel for joint and muscle pain.
• NaproxenIts half-life of 12 to 17 hours makes it longer-acting than ibuprofen (about 2 hours).
• DiclofenacEMA judged its risk of heart attack and stroke to exceed that of other non-selective NSAIDs and to match the selective COX-2 inhibitors', so the same precautions apply.
• AspirinOther NSAIDs affect platelets less, for a shorter time and reversibly; aspirin's block on platelet COX is permanent, which is why it is used as an antiplatelet drug.

• Mild to moderate pain
• Osteoarthritis
• Rheumatoid arthritis
• Period pain (primary dysmenorrhea)
• Acute gout attacks
• Fever

• Stomach and duodenal ulcersKnown forSerious
• Bleeding from the stomach or gutKnown forSerious
• Acute kidney injuryKnown forSerious
• Heart attack and stroke (not with aspirin)Serious
• Raised blood pressure
• Fluid retention and edema
• Worsening heart failureSerious
• High potassium (hyperkalemia)Serious
• Asthma attacks in aspirin-sensitive peopleSerious
• Liver injurySerious

What the class has in common. Each drug's card has its own, and Known for marks what an exam expects you to know.

• Avoid with an active ulcer or past GI bleeding; older age, steroids, anticoagulants and SSRIs add to the bleeding risk.
• Contraindicated around coronary bypass surgery, and in people whose asthma or hives flare after aspirin or another NSAID.
• Kidney disease, dehydration, heart failure, or use with ACE inhibitors, ARBs or diuretics raises the risk of kidney injury.
• Pregnancy: limit use from about 20 weeks (fetal kidney harm) and avoid from 30 weeks (early closure of the ductus arteriosus).

Written for biofideX in plain words, after checking these references:

• Nonsteroidal Antiinflammatory Drug (NCI Thesaurus)
• NSAIDs (NHS)
• Naproxen tablets: label (DailyMed)
• Questions and answers on non-selective NSAIDs and cardiovascular risk (EMA)

For learning pharmacology, not for treatment decisions: no doses are given, and a prescriber, pharmacist or the product's own label is the word on any one patient. Spotted a mistake? Tell us and we'll correct it.