Biography
Biography: Essam Mahran
Abstract
None Steroidal Anti-Inflammatory Drugs (NSAIDs) are analgesic, antipyretic and anti-inflammatory drugs. NSAIDs are commonly used drugs with more than 13 millions chronic users in USA with direct cost more than 2 billion dollars per year. They have serious side effects up to mortality representing 15th commonest cause of death in USA. The NSAIDs are present in the 3 steps of the WHO step ladder analgesic pattern. NSAIDs are classified according to their degree of selectivity on cyclo-oxygenase enzyme into non-selective drugs and newer Cox 2 selective NSAIDs. They vary in their potency, duration and elimination. Because of their CVS risks both Roficoxib and Valdicoxib are withdrawn from the market. GIT risks of gastric erosion and peptic ulcer are more with non selective NSAIDs. Renal side effects result mainly from vasoconstriction of afferent arteriole. Other side effects include allergy and prolonged labor. NSAIDs choice should be tailored to each patient according to his/her age and medical status. In hepatic patients paracetamol can be used in mild to moderate impairment with reduction of the maximum daily dose. In renal impairment NSAIDs, dose adjustments are made according to creatinine clearance. NSAIDs during pregnancy can result in early closure of fetal ductus arteriosus and preterm birth, So NSAIDs are contraindicated in 3rd trimester in France and their FDA approval is category D in third trimester and category C in first and second trimester. During lactation paracetamol, ibuprofen and diclofenac are safe. They vary in their pediatric doses. Celecoxib has also anti-cancer effect.