AINEs

Nonsteroidal anti-inflammatory drugs, or AINEs, are a class of medications that reduce inflammation, pain, and fever. They work mainly by inhibiting the cyclooxygenase enzymes COX‑1 and COX‑2, which decreases the synthesis of prostaglandins that promote inflammation, pain, and fever. Common NSAIDs include aspirin, ibuprofen, naproxen, and diclofenac, which are nonselective COX inhibitors, as well as newer agents with greater COX‑2 selectivity such as celecoxib and meloxicam. They are used for a range of conditions from acute pain and headaches to chronic inflammatory diseases like osteoarthritis and rheumatoid arthritis, often providing relief for mild to moderate symptoms with short- term or long-term use depending on the indication.

Safety and risks: NSAIDs can cause gastrointestinal irritation, ulcers, and bleeding, particularly with long-term use or in older adults. They may affect renal function, cause fluid retention, and increase blood pressure. Some agents carry a higher cardiovascular risk when used long term. Aspirin also reduces platelet aggregation and is used at low doses for cardiovascular protection. Contraindications include active peptic ulcers, significant kidney or liver disease, pregnancy in the later trimesters, and hypersensitivity to NSAIDs. Caution is advised with dehydration, concurrent anticoagulants or corticosteroids, and in older patients. In children, aspirin is generally avoided due to the risk of Reye’s syndrome.

Formulations and administration: NSAIDs are available as oral tablets or suspensions, topical preparations for local pain, and, in some cases, injectable forms for short-term clinical use. The choice of agent depends on efficacy, duration, and patient risk factors.