Talk:Nonsteroidal anti-inflammatory drug
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- 1 Adverse risks of COX-2 inhibitors
- 2 What does "irreversibly inhibit" mean?
- 3 NSAIDs and healing
- 4 Vet uses and misuse
- 5 Non-selective NSAIDs
- 6 Should this be here? Omega-3 Fatty Acids
- 7 Photosensitivity
- 8 The ideal wikipedia article
- 9 Should this be here? Health advice
- 10 Celbrex
- 11 Adverse effects?
- 12 NSAIDS cause heart attacks?
- 13 Daniel L. Simmons external link
- 14 Veterinary Use Claim
- 15 Pronunciation of abbreviation
- 16 Who is this article written for?
- 17 NSAIDs, intestinal permeability, and autoimmune disease
- 18 FDA alert
- 19 What about aspirin and acetominophen/paracetomol?
- 20 Classification "Selective Cox-2 inhibitor" - "NSAIDs can be broadly classified based on their chemical structure"?
- 21 Another NSAID
- 22 Geriatric considerations for NSAID
- 23 Veterinary use
- 24 NSAIDs Side Effects
- 25 Not NSAIDs
- 26 Asthma
- 27 no adverse affects
- 28 Cardiovascular mortality risk section issue
Adverse risks of COX-2 inhibitors
The risk of COX-2 inhibitors causing MI's and other prothrombotic disorders is anecdotal. It might have to do with thromboxane etc. The bottom line is, that statistical evidence is lacking. A huge study would be required that is sufficienty powered for this finding. JFW 12:12, 4 Apr 2004 (UTC)
looking more and more likely, though. gzuckier 2 july 2004
also, i put in a piece on history of nsaids i had lying around (not copyright anywhere else) but it's unwikipediafied as yet. I'll get back to it sometime, but anyone who wants to can obviously chip in. gzuckier 2 july 2004
"In 2001, NSAIDs accounted for 70,000,000 prescriptions and 30 billion over-the-counter sales annually in the United States. (Green, 2001)." This seems incorrect; it implies that the average person in the US purchases NSAIDs every 4 days. Perhaps it is really 30 billion doses? 21 Oct 2004
- While I did not originally put that statement in, I checked that this was the exact wording from the article by Green (2001) when I did the formatting revision a while back. Now that I've looked at the article again, that statement is actually only present in the abstract, and not referenced; so it's perhaps a poor source. But you are right - I wonder if it might perhaps refer to USD$30 billion? Techelf 11:56, 22 Oct 2004 (UTC)
Hmm. This guy says 30 billion over-the-counter tablets sold annually in the United States, which offhand sounds closer to reasonable, but there still is no link to the primary source.
This guy says 30 billion over the counter tablets, but it looks like just a copy of the previous item.
This guy sounds like he's saying $2billion over the counter: "In addition, sales of over-the-counter (OTC) oral analgesics were also very high; about 3 billion dollars were spent, and about 60% of those analgesics included nonsteroidals and aspirin". Most of the articles I looked at also seem to say on the order of $1billion for OTC nsaids, so I think we can rule out $30billion.
this guy says 730 million doses per day in Germany (pop 82 million) with 5% being over the counter, which comes out to..... about .5 doses OTC per person per day, or about 50 billion pills per year for the US. Not too far from 30 billion, considering all the handwaving.
This guy says 26 billion OTC tablets a year, but the original link is gone.
On the preponderance of the evidence, I'd guess it's 30 billion doses/tablets per year, not 30 billion OTC sales, where a sale is a bottle of pills. Agree? Of course, this now opens the can of worms that most of these OTCs seem to count 2 tablets as 1 dose, and the above seem to use tablet and dose interchangably. Then there's the question of whether the 70,000,000 prescriptions cited in the paper are doses or actual prescripotions.... Oy. Gzuckier 16:52, 22 Oct 2004 (UTC)
What does "irreversibly inhibit" mean?
From the article: "Aspirin, the only NSAID able to irreversibly inhibit COX-1,"
As a layman, I don't understand "irreversibly". In someone taking aspirin just once, COX-1 is inhibited until death? I suspect not. :-) Isidore 20:33, 22 Apr 2005 (UTC)
- you are an observant "layman", Izz. i believe it does do it irreversibly, but this refers to "PLATELET" COX, and what limits the duration of its effect is that platelets only live about a week. Sfahey 02:21, 23 Apr 2005 (UTC)
- Indeed, aspirin irreversibly inhibits COX-1. Platelets are unable to synthesise new COX-1 and thus so platelet COX-1 is inhibited for the duration of the platelet's "life" as Sfahey noted. COX-1 in other cells is also irreversibly inhibited, but new COX-1 can be (and is) synthesised in those cells. Techelf 03:32, 23 Apr 2005 (UTC)
Thanks, both. I considered updating the article to clarify this for future readers and, broadening my search, looked at http://www.medicinenet.com/aspirin_and_antiplatelet_medications/article.htm. This also mentions thromboxane A-2 and says aspirin's inhibition of COX-1 lasts much longer than other NSAIDs (not irreversibly). At this point I decided I wasn't qualified to update the article! Isidore 16:55, 23 Apr 2005 (UTC)
Can I suggest to the "layman" that COX-1 inhibition actually refers to inhibition of the cyclooxgenase 1 enzyme rather than the cox1 gene, and so inhibition is irreversible in that it acts until 'death' of the enzyme rather than death of the patient. enzynes have variable lifespan and are continually replaced. Specifically asprin acts by covalent modification of the cyclooxygenase (addition of an acetyl group to Serine 530 residue of the enzyme therby blocking the active site).
- Yes, we were referring to the enzyme COX-1, not the gene. -Techelf 04:10, 14 May 2006 (UTC)
I think the anonymous poster is right, though; "irreversibly" refers to the life of the enzyme, not the platelet. If inhibited by aspirin, it will be inactive for its lifetime, unlike with other, reversible NSAIDs that bounce on and off, competing with substrate (arachidonic acid) for COX-1's active site. The above posters are correct, though, in that platelets cannot produce new COX-1. They contain a lot of it, but they do only live nine to ten days. josta59 28 February 2008
NSAIDs and healing
NSAIDs reduce inflammation, but is that actually good for the healing process? Some papers indicate otherwise:
- A. Beck et al, 2003, "Influence of diclofenac (group of nonsteroidal anti-inflammatory drugs) on fracture healing", Archives of Orthopaedic and Trauma Surgery, 123(7):327-332
(conclusion: NSAIDs delay healing, reduce bone density after trauma in rats)
- D. Marsolais et al, 2003, "Nonsteroidal Anti-Inflammatory Drug Reduces Neutrophil and Macrophage Accumulation but Does Not Improve Tendon Regeneration", Laboratory Investigation, 83:991-999.
Both of these two papers deal with acute trauma rather than chronic inflammation.
On the other hand, arthritis-related papers seem to be only studying symptomatic relief and reduction of gastrintestinal complications when using NSAIDs. So, have there been any studies relating to chronic inflammation and rehabilitation of sports injuries (where most of the problems are related to overuse) that are studying the healing process rather than the symptomatic relief? --Olethros 15:08, 28 March 2006 (UTC)
- NSAIDs are not used to heal things, only to provide symptomatic relief of inflammatory conditions. And you're quite right, they may well be counterproductive in the healing process. -Techelf 11:04, 29 March 2006 (UTC)
Vet uses and misuse
Diclofenac causes death due to renal failre in vultures Use of diclofenac in farm animals in India has lead to a 95% decline in the vulture population, who eat the dead carcasses. Meloxicam seems to safe for vultues. Snowman 09:07, 22 June 2006 (UTC)
Non-selective NSAIDs are safe, despite recent claims that even ibuprofen could worsen cardiovascular risk. So no panic. But naproxen is not protective, knocking a hole in the common defense against the VIGOR study results. JFW | T@lk 16:51, 9 July 2006 (UTC)
- The following drugs, acetylsalicylic acid, salicylic acid and dicrofenac have been found to increase permeability of the intestine allowing food antigens, some potentially allergenic into the system, the effect is augmented by exercise and cause anaphylaxis, a condition that can compicate preexisting cardiovascular risk. The most dangerous of the risk is exercise induced anaphylaxis, with a number of studies showing that aspirin and similar drugs can elevate risk, including low dose aspirin therapy.
"RESULTS: Four cases were diagnosed with wheat allergy, 3 cases had wheat-dependent, salicylic acid-induced anaphylaxis. SPT and CAP-RAST were positive for wheat and gluten in 5 of 7 cases and 4 of 7 cases, respectively. Dicrofenac enhanced the allergic reactions after wheat ingestion in 1 of 2 cases"PubMed
" Immunoreactive gliadins appeared in the sera of patients during the provocation test with both wheat-exercise and wheat-aspirin challenges in parallel with allergic symptom."PubMed
"Oral challenge tests were positive with prawns and prawn extract only if preceded by NSAIDs. Oral challenges with NSAIDs alone, prawns alone, barnacles with or without NSAIDs and alcohol led to no reaction. A synergistic effect of NSAIDs in inducing anaphylaxis after prawn intake was confirmed." PubMed
- Some studies have gone so far as to suggest replacing NSAIDs in patients with a history of sensitivity with omega-3 fatty acid therapy, and the removal of sources of proinflammatory agents, such as arachidonic acid, from the diet. Pdeitiker (talk) 02:19, 11 June 2008 (UTC)
The cardiovascular issue with non-selective NSAIDs is that they raise blood pressure. They don't induce short-term risk of heart attack like COX-2 inhibitors, but over time, increased blood pressure is a serious risk factor. josta59 28 February 2008 —Preceding comment was added at 22:05, 28 February 2008 (UTC)
Should this be here? Omega-3 Fatty Acids
Omega-3 Fatty Acids Drakcap 06:14, 9 October 2006 (UTC)
http://politicaliness.blogspot.com/2013/08/wikipedia.html?spref=fb — Preceding unsigned comment added by Tabshoura (talk • contribs) 18:44, 25 August 2013 (UTC)
The last sentence in this section is: "While ibuprofen is somewhat of an exception, having weak absorption, it has been reported to be a weak photosensitising agent." Does this means that a) usualy low-absorption profens have high photosensitising activity, b) ibuprofen has low photosensitising activity compared to other profens (which corresponds to its relatively low absorption), c) ibuprofen has a weak photosensitising effect, however still much, compared to most non-profens, d) something else. Which is it? Thanks... --Edo11en 17:06, 11 January 2007 (UTC)
The ideal wikipedia article
The ideal wikipedia article about a drug should include the inventor, the patent number URL/link, and the year in which it was invented, for every drug. --SystemBuilder 19:49, 23 February 2007 (UTC)
This is a drug class, not a drug. Also, while I sort of agree with you, I work in this area and rarely see that kind of information. I'm not sure how easy it is to come by. josta59 28 February 2008
Should this be here? Health advice
I'm pretty new here, but I always thought that Wikipedia shouldn't dole out health advice, or that this article should have a template warning against using this as medical advice. I'm sure it would be a pain to go through all the pharmacology articles and alter them, as well as make them uglier, but this page just irked me with its direct advice to the reader: "If you are taking a COX-2 inhibitor, you should not use a traditional NSAID (prescription or over-the-counter)." 22.214.171.124 01:11, 29 March 2007 (UTC)
In Addition Celbrex is a NSAID, but I am not sure which type it is. 17 May 2007
Celebrex is a COX-2-inhibiting NSAID. Fatty acids are not NSAIDs; does that answer your question?josta59 28 February 2008
These rather shocking statistics have no cited source:
"These effects are dose-dependent, and in many cases severe enough to pose the risk of ulcer perforation, upper gastrointestinal bleeding, and death, limiting the use of NSAID therapy. An estimated 10-20% of NSAID patients experience dyspepsia, and NSAID-associated upper gastrointestinal adverse events are estimated to result in 103,000 hospitalizations and 16,500 deaths per year in the United States, and represent 43% of drug-related emergency visits."
What proportion of the general population experience dyspepsia? An 'estimated' 10-20% sounds like it was 'estimated' by someone on a whim rather than as a result of any scientific investigation...
16,500 deaths a year in the US as a result of the use of NSAIDS? An amazing statistic if true - but where's the source??
Dean Morrison 14:13, 30 September 2007 (UTC)
NSAIDS cause heart attacks?
I'm curious about the claim that NSAIDS cause heart attacks. The literature I've read suggests that they reduce them. see
I've looked at the underlying article and it specifically excluded aspirin. Also, it only supported correlation. It did not prove causation. I've adjusted the article accordingly. Can anyone support a causal link?--Ryan Wise (talk) 05:27, 22 March 2008 (UTC)
- See [way] above. As you see the advertisement on celebrex, the same is true for most NSAIDs, NSAIDs can cause the microperforations in the mucosa of the small intestine. Strenuous exercise, or even a heavy meal, can cause the induction of food peptides (namely gliadin and crustacean proteins). This can cause exercise-induced anaphylaxis, which is sometimes cause fatal cardiac arrest (among other things). Some of the 'sensitivity' seen to NSAIDs is actually do to allergic reaction to food proteins such as atopy, urticaria, etc. PubMed Pdeitiker (talk) 02:37, 11 June 2008 (UTC) [hope this is 'causal' enough for you]
Veterinary Use Claim
"the only NSAID currently available for labelled use in the United States is flunixin meglumine" What about carprofen/Rimadyl? —Preceding unsigned comment added by Sparge (talk • contribs) 15:15, 24 October 2008 (UTC)
- Oh hey, another example! I know nothing whatsoever about carprofen/Rimadyl, but it'd be great if someone else who does (or feels they have the time and inclination to educate themselves just for Wikipedia) could add that as a third example in the Veterinary section. If anyone ever gets round to adding an example beyond three, though, it would probably be best to format the NSAIDs, the relevant species and prescription statuses and so on, in bulleted-list and/or chart form. The paragraph's already a bit unwieldy. (I'm amazed that inaccurate claim was there in the article for over 2 years! Wish you'd added your example earlier, Sparge; remember, be bold — your factual contribution can always be tweaked later, for tone, references, readability or anything else needed.) --126.96.36.199 (talk) 17:19, 14 February 2011 (UTC)
Pronunciation of abbreviation
The abbreviation "NSAIDs" is pronounced as "EN-sedz" by I think everyone I've worked with as a Medical Secretary in hospitals in England. Is this universal? I couldn't find any pronunciation information in the article as it is, and I certainly think it's worth including. For those who abbreviate it as "NAIDs" (which I personally don't recall ever seeing or hearing), how would this be pronounced? leevclarke (talk) 17:11, 9 January 2009 (UTC)
For what it's worth, in a drug ad on American TV, I heard NSAID pronounced EN-sed. So on this side of the pond, it's probably pronounced the same way you lot say it. In my head, I'd always sounded it out as EN-sayed, and so maybe there is a case for putting a pronunciation guide in the article. I do work in a medical setting, so I'll ask the docs who work here what they say. If I get a consensus, I'll add in a pronuciation guide. --Spiff666 (talk) 14:56, 30 January 2009 (UTC)
- See this Merriam-Webster entry and then compare another Merriam-Webster source that is subtly different.LeadSongDog come howl 16:01, 16 June 2009 (UTC)
Who is this article written for?
Who is this article written for? Seems like it might possibly be of interest to a pot-smoking junior drug researcher, but certainly not of interest to a layperson seeking information about NSAID's. 19 March 2009 —Preceding unsigned comment added by 188.8.131.52 (talk) 03:36, 20 March 2009 (UTC)
- I'm a layperson seeking information about NSAID's, and I liked it.184.108.40.206 (talk) 00:22, 4 November 2009 (UTC)
I agree with the first comment, unfortunately this the case with many articles in Wikipedia, and as a result Wikipedia is in danger of becoming a technical reference rather than a general encyclopedia. —Preceding unsigned comment added by 220.127.116.11 (talk) 11:36, 23 June 2010 (UTC)
NSAIDs, intestinal permeability, and autoimmune disease
This edit. An editor has reverted my removal earlier today of this passage: "NSAIDs are also associated with an increase in permeability of the small intestine due to suppression of COX-1 and COX-2 prostaglandins, which are responsible for maintaining the integrity of the intestinal barrier. Increased permeability of the small intestine has been linked to auto-immune disorders including Crohn's disease and Type 1 Diabetes", citing PMID 16966705.
The reference provided does not provide evidence for a link between NSAIDs, intestinal permeability, and autoimmune disease; in fact the only mention of NSAIDs in that article indicates that they were considered possibly to be responsible for increased intestinal permeability in persons with ankylosing spondylitis, but a "primary defect" was found to be responsible, and was also detected in relatives. Thus, the edit in this article represents synthesis, as I indicated in my prior edit summary. -- Scray (talk) 03:59, 31 October 2009 (UTC)
FDA website is a mess, which is why all the FDA links are dead. Here is a current link: http://www.fda.gov/downloads/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm124654.pdf —Preceding unsigned comment added by 18.104.22.168 (talk) 03:00, 4 November 2009 (UTC)
What about aspirin and acetominophen/paracetomol?
Aspirin is certainly thought of as an NSAID and has an acetyl group - should it be included in the "acetic acid derivative" group under Classifications?
Note this passage in the article on aspirin: "Aspirin was the first discovered member of the class of drugs known as nonsteroidal anti-inflammatory drugs (NSAIDs), not all of which are salicylates, although they all have similar effects and most have inhibition of the enzyme cyclooxygenase as their mechanism of action."
acetominophen/paracetomol (Tylenol) is perhaps a borderline case, but should fit in somewhere. "[Paracetamol] is often classified as a nonsteroidal anti-inflammatory drug (NSAID), but paracetamol has few anti-inflammatory effects in many tissues. However, aspirin, paracetamol and other NSAIDs all act by the same mechanism (inhibition of prostaglandin synthesis) and all show varying levels of analgesic, anti-inflammatory, antipyretic and antiplatelet actions." (see Paracetamol) Johnfravolda (talk) 19:05, 24 June 2010 (UTC)
- You are right about paracetamol, see Hinz et al 2008 in the references for some details about mechanism of (NSAID) action. Some time ago someone had a strong drive to characterize paracetamol as not-NSAID and the articles still show traces of this.. paracetamol definitely belongs here. Not sure how it could happen that aspirin is not here. Richiez (talk) 23:04, 24 June 2010 (UTC)
Classification "Selective Cox-2 inhibitor" - "NSAIDs can be broadly classified based on their chemical structure"?
This grouping is clearly relevant but does not seem to fit neatly under the idea of classification by chemical structure. What is the common chemical feature? Perhaps the classification system should be modified? Johnfravolda (talk) 19:05, 24 June 2010 (UTC)
- Sure it does not fit neatly, it is more like a historical classifiaction. Before COX was known stuff was classified by chemical origin, later by presumed mechanism of action. Richiez (talk) 23:12, 24 June 2010 (UTC)
Geriatric considerations for NSAID
Sorry, I don't have cites, though there are some at the articles for the three medications named and linked to. I do know the cites are out there. I just saw that the section seemed to be saying that only one NSAID was approved for veterinary use in any animals in the U.S., which is definitely not the case. I re-worded the existing example to make it clearer that it was only one example. (I know nothing about veterinary care of livestock and would have to climb a steep learning curve to be able to fact-check the studies, regulation, off-label use, efficacy etc. for either of the specific NSAIDs mentioned other than Metacam.) I added the second example because, as it happens, my poor kitty who's already been battling a terminal cancer has also developed bad enough arthritis that she's limping, and her oncologist and regular vet concurred that Metacam was the only real option for reducing the joint swelling and/or increasing her mobility... and, after the big bold warnings on the packaging made me call the office before administering the first dose, our awesome vet double-checked the literature and explained why the warning was there, when and where it was still used in cats, and what to watch out for should any adverse reaction occur so we can catch and treat it early; so I knew a fair bit about Metacam's status in the U.S. and the Wiki article on it provided the additional info about its status in other jurisdictions.
Made some edits to the "Veterinary Use" section. Changed reference from Meloxicam to Metacam. While Meloxicam is the generic drug form, the label claims (at least in Canada) are specific to the formulation, which makes it important to use the specific product name. Most formulations of meloxicam have *no* claim for use in veterinary species, and are rather human drugs that we 'appropriate' for that purpose.
Also changed the comment about "the use in cats isn't prohibited in the EU" (or something along those lines). To my knowledge, the use in cats isn't "prohibited" anywhere (there are warnings, but there is freedom for veterinarians to go 'off-label'.) In fact I'm not aware of a single drug that is out and out prohibited in companion animals (food animals are a totally different story), instead I reworded to say that they have label claims in those countries.
I'm not totally happy with this section though, as I'm not sure that this information really belongs here in the first place (on information about a particular class of drugs). It really isn't complete, and to make it complete would probably be beyond the scope of this article --- is it better to have a partial story? Or the full story?
- I saw your comment here after making edits to the article, but I still feel use of generic name is more appropriate in WP, absent evidence that the generic is not bioequivalent. -- Scray (talk) 16:35, 23 April 2011 (UTC)
In this case the point of referring to Metacam specifically is that it is the branded Metacam that is (in some countries) licensed for use with animals. In the UK, for instance, vets legally cannot prescribe the generic if there is a branded, licensed version therefore to refer to Meloxicam would be inaccurate.
In the UK and Australia (and possibly elsewhere) there is a specific feline formulation of Metacam so it isn't being used "off-label" or "off-license", it is approved for feline use. PurplePenny (talk) 13:35, 17 October 2011 (UTC)
NSAIDs Side Effects
With benefits there are equally side effects of NSAIDs as well. Based on these studies, the most common NSAID side effects include:
- Abdominal pain (stomach pain)
- An unexplained rash
Where is the reference that puts glucosamine and chondroitin into the NSAID class ("Other" category in the table)? Those substances may have pharmacological properties, but I think it is misleading to list them as NSAIDs.LM6407 (talk) 07:37, 26 December 2012 (UTC)
Looking in the asthma article I see that NSAIDs may have an adverse effect - did I understand that correctly (not an expert and the linked reference is a bit technical)? I'm fairly sure that I've been advised against using ibuprofin (which I think is an nsaid) as I'm asthmatic. If that is correct it probably ought to get a mention in the nsaid article. EdwardLane (talk) 12:21, 2 April 2013 (UTC)
no adverse affects
Why can't they make a no adverse affect drug? Which one is least adverse? also do these adverse affects cause insommnia? I am a warehouse worker which causes body aches. So I need a low cost low adverse product to relieve me of body aches regularly. Mrp8196 (talk) 16:52, 10 January 2014 (UTC)
Cardiovascular mortality risk section issue
In the section "Cardiovascular":
"In people with heart failure, NSAIDs increase mortality risk by approximately 1.2-1.3 for naproxen and ibuprofen, 1.7 for rofecoxib and celecoxib, and 2.1 for diclofenac."