Prostaglandins are a family of chemicals that are produced by the cells of the body and have several important functions. They promote inflammation that is necessary for healing, but also results in pain, and fever; support the blood clotting function of platelets; and protect the lining of the stomach from the damaging effects of acid.
Prostaglandins are produced within the body's cells by the enzyme cyclooxygenase (COX). There are two COX enzymes, COX-1 and COX-2. Both enzymes produce prostaglandins that promote inflammation, pain, and fever. However, only COX-1 produces prostaglandins that support platelets and protect the stomach.
Nonsteroidal anti-inflammatory drugs (NSAIDs) block the COX enzymes and reduce prostaglandins throughout the body. As a consequence, ongoing inflammation, pain, and fever are reduced. Since the prostaglandins that protect the stomach and support platelets and blood clotting also are reduced, NSAIDs can cause ulcers in the stomach and promote bleeding.
NSAID Classes
- Acetic acids
- COX-2 inhibitors
- Fenamates
- Oxicam derivatives
- Propionic acids
- Salicylates
Acetic acids
Diclofenac
Etodolac
Indomethacin
Ketorolac
Nabumetone
Sulindac
Tolmetin
COX-2 inhibitors
Celecoxib
Fenamates
Meclofenamate
Mefenamic acid
Oxicam derivatives
Meloxicam
Piroxicam
Propionic acids
Fenoprofen
Flurbiprofen
Ibuprofen
Ketoprofen
Naproxen
Oxaprozin
Salicylates
Aspirin
Diflunisal
Magnesium salicylate
Salsalate
Side Effects of NSAIDs
Most people tolerate NSAIDs without any difficulty. However, side effects can occur. The most notable side effects include the following:
Cardiovascular system - Blood pressure may rise with use of NSAIDs. Control of treated hypertension may be adversely affected by the addition of either selective or nonselective NSAIDs.
Gastrointestinal system - Short-term use of NSAIDs can cause stomach upset (dyspepsia). Long-term use of NSAIDs, especially at high doses, can lead to peptic ulcer disease and bleeding from the stomach.
Liver toxicity - Long-term use of NSAIDs, especially at high doses, can rarely harm the liver. Monitoring the liver function with blood tests may be recommended in some cases.
Kidney toxicity - Use of NSAIDs, even for a short period of time, can harm the kidneys. This is especially true in people with underlying kidney disease. The blood pressure and kidney function should be monitored at least once per year but may need to be checked more often, depending on a person’s medical conditions.
Ringing in the ears - Ringing in the ears (tinnitus) is common in people who take high doses of aspirin, although it is very uncommon for this to occur in people who take other NSAIDs. The ringing usually resolves when the dose is decreased.
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Side Effects of NSAIDs
Most people tolerate NSAIDs without any difficulty. However, side effects can occur. The most notable side effects include the following:
Cardiovascular system - Blood pressure may rise with use of NSAIDs. Control of treated hypertension may be adversely affected by the addition of either selective or nonselective NSAIDs.
Gastrointestinal system - Short-term use of NSAIDs can cause stomach upset (dyspepsia). Long-term use of NSAIDs, especially at high doses, can lead to peptic ulcer disease and bleeding from the stomach.
Liver toxicity - Long-term use of NSAIDs, especially at high doses, can rarely harm the liver. Monitoring the liver function with blood tests may be recommended in some cases.
Kidney toxicity - Use of NSAIDs, even for a short period of time, can harm the kidneys. This is especially true in people with underlying kidney disease. The blood pressure and kidney function should be monitored at least once per year but may need to be checked more often, depending on a person’s medical conditions.
Ringing in the ears - Ringing in the ears (tinnitus) is common in people who take high doses of aspirin, although it is very uncommon for this to occur in people who take other NSAIDs. The ringing usually resolves when the dose is decreased.
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