NSAIDs

NSAIDs, or nonsteroidal anti-inflammatory drugs, are a class of medications that reduce inflammation, pain, and fever by inhibiting cyclooxygenase enzymes and lowering the production of prostaglandins.

They inhibit COX-1 and COX-2 enzymes; most NSAIDs act as reversible inhibitors, while aspirin irreversibly inhibits COX-1 in platelets, contributing to its antiplatelet effects. COX-2 selective inhibitors (such as celecoxib) were developed to lower gastrointestinal toxicity, but they may carry higher cardiovascular risks in some patients. Traditional NSAIDs include ibuprofen, naproxen, diclofenac, indomethacin, and ketorolac.

Common uses of NSAIDs include relief of mild-to-moderate pain, inflammatory conditions such as osteoarthritis and rheumatoid arthritis, menstrual cramps, dental pain, and fever reduction.

Safety and risks are important considerations. NSAIDs can cause gastrointestinal irritation, ulcers, and bleeding; they may affect kidney function and can raise blood pressure or worsen heart failure in susceptible individuals. They can interact with anticoagulants, certain antihypertensives, diuretics, and corticosteroids. The risk of adverse events is higher in the elderly and in people with kidney disease or peptic ulcers. Caution is advised in individuals with asthma or aspirin sensitivity.

Pregnancy considerations vary by stage; NSAIDs are generally avoided in the third trimester due to risks to the fetus and labor. In lactation, most NSAIDs are used cautiously or avoided depending on the agent. For all NSAIDs, using the lowest effective dose for the shortest duration helps mitigate risks.