Non-steroidal antiphlogistics

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  • Citation tools Download this article to citation manager Day Richard O , Graham Garry G . Non-steroidal anti-inflammatory drugs (NSAIDs) BMJ 2013; 346 :f3195
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    Prescription NSAIDs are an important treatment for the symptoms of many debilitating conditions, including osteoarthritis, rheumatoid arthritis‎, gout and other rheumatological and painful conditions. OTC NSAIDs are used to temporarily reduce fever and to treat minor aches and pains such as headaches, toothaches, backaches, muscular aches, tendonitis, strains, sprains and menstrual cramps. Common OTC NSAIDs include ibuprofen (Motrin, Advil) and naproxen (Aleve). In addition, some combination medicines that relieve various symptoms, such as multi-symptom cold products, contain NSAIDs.

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    NSAIDs may reduce the benefit of drugs used for treating hypertension because NSAIDs may increase blood pressure . NSAIDs decrease the elimination of lithium ( Eskalith ) and methotrexate ( Rheumatrex ) potentially leading to their toxicity , and reduce the action of diuretics (" water pills") by reducing blood flow to the kidneys. NSAIDs increase bleeding by decreasing the activity of blood platelets and therefore formation of blood clots. When used with other drugs that also increase bleeding, for example, warfarin ( Coumadin ), the likelihood of bleeding complications is increased. Prolonged use of NSAIDs with drugs that increase bleeding should be avoided.

    Limited evidence supported the use of NSAIDs in the treatment of acute gout. One placebo-controlled trial provided evidence of benefit at 24 hours and little or no harm. We downgraded the evidence due to potential selection and reporting biases, and imprecision. While these data were insufficient to draw firm conclusions, they did not conflict with clinical guideline recommendations based upon evidence from observational studies, other inflammatory arthritis and expert consensus, which support the use of NSAIDs in acute -quality evidence suggested that selective COX-2 inhibitors and non-selective NSAIDs are probably equally beneficial although COX-2 inhibitors are likely to be associated with significantly fewer total and gastrointestinal adverse events. We downgraded the evidence due to an unclear risk of selection and reporting biases. Moderate-quality evidence indicated that systemic glucocorticoids and NSAIDs were also equally beneficial in terms of pain relief. There were no withdrawals due to adverse events and total adverse events were similar between groups. We downgraded the evidence due to unclear risk of selection and reporting bias. There was low-quality evidence that there was no difference in function. We downgraded the quality due to unclear risk of selection bias and imprecision.

    Non-steroidal antiphlogistics

    non-steroidal antiphlogistics

    NSAIDs may reduce the benefit of drugs used for treating hypertension because NSAIDs may increase blood pressure . NSAIDs decrease the elimination of lithium ( Eskalith ) and methotrexate ( Rheumatrex ) potentially leading to their toxicity , and reduce the action of diuretics (" water pills") by reducing blood flow to the kidneys. NSAIDs increase bleeding by decreasing the activity of blood platelets and therefore formation of blood clots. When used with other drugs that also increase bleeding, for example, warfarin ( Coumadin ), the likelihood of bleeding complications is increased. Prolonged use of NSAIDs with drugs that increase bleeding should be avoided.

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