Non-steroidal anti-inflammatory drugs (NSAIDs) are a class of anti-inflammatory drugs that do not contain steroidal structures. NSAIDs have been marketed for more than 100 years since aspirin was first synthesized in 1898, and more than 100 kinds of thousands of brands have been marketed, including aspirin, indomethacin, naproxen, diclofenac, ibuprofen, rofecoxib, celecoxib, etc. This class of drugs has anti-inflammatory, analgesic, antipyretic and anticoagulant effects, and is They are widely used clinically for the relief of osteoarthritis, rheumatoid arthritis, multiple fevers and various pain symptoms.
NSAIDs are currently one of the most prescribed and widely used drugs in the world, with about 30 million people using them every day worldwide. They have relieved pain and provided relief to many patients and are well received by clinicians, pharmacists and patients. However, with the popularity of NSAIDs, some unregulated use methods and adverse consequences caused by them have been reported repeatedly, and their safe use has received increasing attention from the society. Many NSAIDs are now available as over-the-counter (OTC) drugs, which patients can purchase directly from pharmacies without a physician’s prescription. Therefore, it is necessary to remind everyone to pay attention to and understand the regulated use of NSAIDs drugs.
Before introducing the rational use of NSAIDs drugs, first of all, we should understand their adverse reactions, which is the beginning of a comprehensive and correct understanding of NSAIDs drugs. Its adverse reactions are mainly manifested in the following aspects.
1, gastrointestinal tract damage
This is the most common adverse reactions of NSAIDs, can cause indigestion, mucosal erosion, gastric and duodenal ulcer bleeding, serious cases can cause perforation. The United States has 14 million patients with osteoarthritis long-term use of NSAIDs, NSAIDs caused by the number of gastrointestinal damage accounted for 2% to 3% each year, more than 20,000 people died each year from complications of gastrointestinal damage, only for the treatment of gastric damage complications costs up to 3.9 billion dollars. Domestic NSAIDs are also very widely used, coupled with the abuse of the phenomenon is more serious, the incidence of gastrointestinal damage remains high.
2, kidney damage
The renal damage caused by NSAIDs is manifested as acute renal insufficiency, interstitial nephritis, renal papillary necrosis and water-sodium retention, hyperkalemia, etc. The incidence accounts for 37% of all drugs that can cause renal insufficiency.
3. Liver damage
Most NSAIDs can lead to liver damage, jaundice, hepatitis, granulocytopenia, aplastic anemia, transaminase elevation and other adverse reactions, such as long-term use of large amounts can lead to acute toxic hepatic necrosis, serious cases can lead to coma or even death.
4.Cardiovascular damage
COX-2 inhibitor is a new type of NSAIDs drugs, due to less gastrointestinal adverse reactions, since the 1990s applied to clinical use, the dosage has been climbing. However, in 2002, it was found that COX-2 inhibitors can produce cardiovascular damage, such as hypertension, coronary heart disease and myocardial infarction and other adverse reactions can occur. The U.S. FDA required some products such as Wanluo withdrawn and discontinued, and some other products were required to be specifically marked in the instructions with a black box warning that the drug has cardiovascular adverse reactions.
5.Capping effect
NSAIDs drugs have a capping effect (extreme limit), that is, after reaching a certain dose, even if the drug dose is increased, not only its pharmacological effects are not enhanced, but its side effects are increased.
We understand the above NSAIDs drug adverse reactions, in the actual application, you can do the following aspects of reasonable standardized use, to prevent adverse reactions.
1, the dose of drugs vary from person to person, using the minimum effective dose and the shortest course of treatment
For special groups of people should be individualized administration, such as children because of cardiovascular vulnerability, should be avoided or reduced; 60 years of age or older, the gastrointestinal tract poor tolerance, liver and kidney function is reduced, but also cardiovascular disease, should be used under the strict guidance of doctors. Avoid high-dose, long-term application of NSAIDs as much as possible; when long-term use is required, it should be used under the guidance of a physician or pharmacist, and attention should be paid to monitoring possible damage to various systems, organs and tissues during the use of the drug. When using, you should read the instructions carefully and use the drug strictly in accordance with the instructions.
2. The following conditions should be prohibited or used with caution
Active peptic ulcer and recent gastrointestinal bleeding, hypersensitivity to aspirin or other NSAIDs, hepatic insufficiency, renal insufficiency, severe hypertension and congestive heart failure, hemocytopenia, pregnancy and lactation.
3. Combined medication
For patients with peptic ulcer who must use anti-inflammatory and analgesic drugs, gastric mucosal protective agents can be used in combination to reduce the damage to the gastrointestinal tract. Stop the drug immediately if there are suspected adverse reactions, consult a physician or pharmacist to decide whether to continue using the drug, and if necessary, give appropriate treatment for adverse reactions.
4. Alcohol should not be consumed during the medication period, otherwise it will increase the irritation of the gastrointestinal mucosa. It should not be used in combination with anticoagulants (e.g. warfarin), otherwise it may increase the risk of bleeding.
5, should not use two or more NSAIDs drugs at the same time
This can lead to the superposition of adverse reactions. Pay special attention to the multiple names of a drug, the same chemical composition of the drug may appear under different trade names, should avoid repeated use of drugs. For example, acetaminophen, also known as paracetamol, has trade names such as Benadryl, Tylenol, and Piriton; diclofenac, also known as diclofenac, has trade names such as Intravenous, Fotalin, Daphne, and Aubert.
The withdrawal of Wanluo (rofecoxib) from the global market in October 2004 is an example.
7, on the basis of a full understanding of the adverse drug reactions to NSAIDs, patients do not have to worry too much. The proportion of NSAIDs in our reports on adverse drug reactions is not large. Therefore, not all patients using NSAIDs, the above-mentioned adverse reactions will definitely occur.
In conclusion, only when physicians, pharmacists, patients and the society pay attention to the safe use of NSAIDs drugs together, insist on the rational use of drugs, and try to avoid and reduce the adverse drug reactions, we can really build a barrier of safe drug use, so that everyone can really enjoy the benefits brought to us by NSAIDs drugs.