Talk:Nonsteroidal anti-inflammatory drug

Should this be here?

Omega-3 Fatty Acids Drakcap 06:14, 9 October 2006 (UTC)

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)

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

Non-selective NSAIDs are safe, despite recent claims that even ibuprofen could worsen cardiovascular risk[1]. 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)

Photosensitivity

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)