NSAID

NSAIDs, or non-steroidal anti-inflammatory drugs, are a class of medications that reduce inflammation, pain, and fever by inhibiting the activity of cyclooxygenase (COX) enzymes, COX-1 and COX-2, which lowers the synthesis of prostaglandins. They are non-opioid analgesics used for mild to moderate pain and inflammation, and may be used for fever and certain types of headache or migraine, depending on the agent.

Common NSAIDs include ibuprofen, naproxen, diclofenac, indomethacin, ketorolac, meloxicam, piroxicam, and aspirin. Acetaminophen is not an NSAID and works by a different mechanism. NSAIDs vary in COX selectivity and duration of action, with some preferentially inhibiting COX-2. Aspirin is notable for an irreversible antiplatelet effect and is sometimes used for cardiovascular prevention in low doses.

Safety and adverse effects: Inhibition of COX-1 can irritate the stomach lining and impair platelet function, increasing risk of gastritis, ulcers, and bleeding. Prolonged use or high doses may cause kidney impairment and fluid retention; some people have cardiovascular risks, with COX-2 selective agents linked to thrombosis and heart failure in susceptible individuals. Contraindications include active GI bleeding, severe kidney disease, and hypersensitivity to NSAIDs. Use with caution in the elderly, pregnant women, and those taking anticoagulants or other nephrotoxic drugs.

Pharmacokinetics: most NSAIDs are administered orally, with peak plasma levels within 1–2 hours (some are topical or administered rectally). They are largely metabolized in the liver and eliminated by the kidneys. Dosing and duration depend on the specific drug and condition.