Nonsteroidal anti-inflammatory drugs - a panacea or a slow killer?

Most often in clinical practice applynonsteroidal anti-inflammatory drugs, or NSAIDs. They are prescribed for inflammatory processes of a variety of etiologies for localization of the inflammation focus, removal of pain syndrome, fever, reduction in the risk of thrombosis (habitual aspirin). According to WHO statistics, these preparations consume about 30 million people every day, and only a third of them are prescribed by a doctor. Even more impressive figures, in particular, for rheumatic diseases. It turned out that anti-inflammatory drugs for joints are prescribed by about 80% of rheumatologists.

But are these medicines as harmless as they are popular? Clinical efficacy has not been questioned, but has a number of limitations, because even small doses during short-term admission can cause side effects in 25% of patients, and in 5% of cases they pose a threat to life. Especially, this applies to the elderly, and it is they who account for 60% of all NSAIDs.

When in the 70's they discovered the principle of actionThese drugs (inhibition of cyclooxygenase activity, the main enzyme involved in the metabolism of prostaglandins), it became clear that the side effect would necessarily be the development of pathologies of the renal circulation and gastrointestinal tract. After all, prostaglandins (PG) play a huge role here. In the 90s, new facts emerged about the role of PG in the course of the most important processes in the human body. Accordingly, anti-inflammatory drugs uplift the whole spectrum of vital reactions, in particular, blood clotting and vascular tone, bone metabolism, embryogenesis, growth of cells of the nervous system, tissue repair and many others.

At the same time, it was revealed that there are twoisoforms of cyclooxygenase: COX-1 and COX-2. Moreover, the first is responsible for the normal functioning of the organs at the cellular level, and inhibition of the second one shows the curative effect. Thus, producing anti-inflammatory drugs that can selectively affect COX-2, you can minimize the occurrence of most side effects and secure treatment.

One such selective agent is ibuprofen. According to almost all studies, the risk of gastrointestinal pathology when taking it is minimal compared to, for example, piroxicam.

More recently, anothera side effect that causes non-steroidal anti-inflammatory drugs. They significantly reduce the tone of the vessels, which is especially dangerous for people suffering from cardiac pathologies. On the background of NSAIDs, there is usually an increase in blood pressure, and in fact the majority of elderly people who are prescribed these drugs for rheumatic pain usually already have an anamnesis of hypertension.

In addition, NSAIDs reduce efficacydiuretic effect of many antihypertensive drugs. In particular, the average therapeutic doses of indomethacin, piroxicam and naproxen nullify the intake of drugs containing furosemide and hypothiazide, such as the drugs prazosin or captopril. However, it also became known that preparations of selective action on different isoforms of COX, mentioned above, do not significantly affect the cardiovascular system. Thus, there remains a large field of activity to create highly selective drugs with minimal effect on blood pressure, and the most suitable for older people. And such drugs have already begun to appear. For example, in the case of COX-2, meloxicam, celecoxib, has a significant selectivity.

Unfortunately, not only elderly people often themselvesprescribe non-steroidal anti-inflammatory drugs for a cold, for example, not understanding all the possible consequences. NSAIDs are really difficult to replace, but only a qualified doctor is able to evaluate the effectiveness of a given drug for all possible risks.

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