Complications from anti-inflammatory drugs can be prevented

The range of indications for which non-steroidal anti-inflammatory drugs are used is quite wide, and therefore patients often take them uncontrollably in various painful conditions – from fever to pain. Such a breadth and often unreasonable use of NSAIDs leads to the development of side effects, including quite serious ones. Complications from anti-inflammatory drugs may be associated with excess dosage, increased sensitivity of the body to certain drugs, an allergic reaction.

 

Non-steroidal anti-inflammatory drugs are taken by one in five people worldwide, usually caused by diseases of the musculoskeletal system, pain syndromes, neurological and many other diseases. The range of NSAIDs today is quite wide, but their uncontrolled use is fraught with the development of adverse reactions, which may be due to the following reasons:

• drug overdose (relative and absolute);
• pharmacological properties of the medicinal product;
• violation of the immunobiological properties of the body;
• allergy;
• idiosyncrasy;
• withdrawal syndrome.
• Most often, complications from anti-inflammatory drugs are caused directly by their pharmacological action.

 

Features of the effects of NSAIDs on the human body

The mechanism of action of NSAIDs, which determines its effectiveness and its toxicity, is associated with the suppression of cyclooxygenase (COX) activity – a key element that is produced during the metabolism of arachidonic acid. Today two isoforms of COX are known – the first regulates the synthesis of elements that protect the kidneys and the mucous membrane of the digestive tract from damage, and the second is responsible for the course of inflammatory processes.

NSAIDs act selectively for cyclooxygenase, and this property was taken as the basis for the classification:

• selective COX-1 inhibitors (contain very little acetylsalicylic acid, which can damage the mucous membrane);
• COX-1 and COX-2 inhibitors (most modern NSAIDs);
• selective COX-1 and COX-2 inhibitors;
• specific COX-2 inhibitors.
• The higher the level of specificity of NSAID action, the lower the risk of developing complications from anti-inflammatory drugs.

 

Most common complications from anti-inflammatory drugs

One of the most frequent complications when taking NSAIDs – this is a gastropathy, which includes gastritis-like changes, the development of erosions and ulcers, united by one cause. This is the body's reaction to the suppression of the production of gastroprotective elements, when the balance between the protective factors of the mucous membrane of the digestive tract and the factors of aggression is disturbed. The most common cause of NSAID gastropathy is the intake of ketorolac and piroxicam, in about 40% of patients an ulcer or erosion of the stomach is found. Subjectively, patients with long-term use of NSAIDs report abdominal pain, heartburn, and impaired intestinal motility.

The second most common complication from taking anti-inflammatory drugs – these are side effects that are possible & nbsp; from the side of the central nervous system. So, for example, in the treatment with indomethacin, headaches, depression, insomnia, dizziness, tremors are noted; taking meloxicam causes drowsiness, blurred vision; salicylates can provoke tinnitus and hearing loss, while taking ibuprofen, sulindac, cases of aseptic meningitis are described.

In elderly patients, taking NSAIDs can cause an increase in blood pressure, increase the risk of circulatory decompensation, which affects the survival of patients with heart failure.

NSAID hepatotoxicity is manifested in an increase in the level of liver enzymes, the development of cholestasis. Cases of idiosyncratic hepatitis have been described in cases of the use of diclofenac and indomethacin, which is especially severe in children. Reversible renal failure may occur.

In patients with bronchial asthma, hypersensitivity reactions to acetylsalicylic acid may develop – shortness of breath, bronchospasm.

Sometimes, complications from anti-inflammatory drugs can manifest as fever, myocarditis, anemia, stomatitis, photosensitivity, urticaria, erythema multiforme.

 

Dangers of combining NSAIDs with drugs of other groups

Many patients take drugs from different groups at the same time, especially for chronic diseases, and therefore the doctor should pay attention to the possible interaction of NSAIDs and other drugs. For example, the combination of NSAIDs with warfarin increases the risk of bleeding and damage to the gastric mucosa. Simultaneous use of NSAIDs with ACE inhibitors, with diuretics neutralizes their effect, but the concentration of methotrexate or digoxin – on the contrary, it can increase in combination with NSAIDs and have a toxic effect on the body.

Thus, the choice of the best NSAID for the patient is carried out taking into account a whole range of factors – safety, efficacy, selectivity, compatibility with other drugs, the presence of concomitant pathologies, individual sensitivity of the patient. It should be borne in mind that NSAIDs – these are not only indispensable drugs in the treatment of many diseases, but also a possible cause of the development of complications caused both by the drug itself and its interactions.