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

Most often, non-steroidal anti-inflammatory drugs, or NSAIDs, are used in clinical practice. They are prescribed for inflammatory processes of a variety of etiologies for localization of the inflammation focus, removal of pain syndrome, fever, reducing 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 can cause side effects in a short-term admission in 25% of patients, and in 5% of cases they pose a threat to life. Especially, it concerns elderly people, and after all, they account for 60% of all NSAID users.

When in the 70s the principle of action of these drugs was discovered (inhibition of the activity of cyclooxygenase, 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 1990s, 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 coagulation and vascular tone, bone metabolism, embryogenesis, growth of the cells of the nervous system, tissue repair and many others.

At the same time, it was found that there are two isoforms of cyclooxygenase: COX-1 and COX-2. Moreover, the first is responsible for the normal functioning of organs at the cellular level, and the inhibition of the second is manifesting the therapeutic 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 in comparison with, for example, piroxicam.

More recently, another side effect has been discovered 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 most of the elderly who are prescribed these drugs for rheumatic pain usually already have an anamnesis of hypertension.

In addition, NSAIDs reduce the effectiveness of the diuretic 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, which were 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, with respect to COX-2, meloxicam, celecoxib, has a significant selectivity.

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