Short Overview on NSAIDs and Narcotic Analgesics

In includes Classification, Mechanism, Indications, Adverse Effects & Drug Interactions

Classification of NSAIDs

Non-selective COX Inhibitors:

·  Salicylates: Aspirin

·  Propionic acid derivatives: Ibuprofen, Naproxen

·  Acetic acid derivatives: Indomethacin, Diclofenac

·  Fenamates: Mefenamic acid

·  Oxicams: Piroxicam

·  Others: Nimesulide

Preferential COX-2 Inhibitor:

• Nimesulide

Selective COX-2 Inhibitors:

• Celecoxib, Etoricoxib

Mechanism of Action - NSAIDs

NSAIDs inhibit Cyclooxygenase (COX):

• COX-1: Protective prostaglandins (GI, kidney, platelets)
• COX-2: Inflammatory prostaglandins

Result:

• Decreased prostaglandin synthesis
• Anti-inflammatory, analgesic, antipyretic effects

 

Indications - NSAIDs

• Pain (mild to moderate)
• Fever
• Inflammatory diseases (e.g., arthritis)
• Dysmenorrhea
• Cardioprotection (Aspirin in low doses)

 

Adverse Effects - NSAIDs

• Gastrointestinal irritation, ulcers
• Renal impairment
• Increased cardiovascular risk (COX-2 inhibitors)
• Hepatotoxicity (e.g., Nimesulide)
• Hypersensitivity reactions

 

Drug Interactions - NSAIDs

• Warfarin/anticoagulants: ↑ Bleeding
• Antihypertensives: ↓ Effectiveness
• Methotrexate: ↑ Toxicity
• Lithium: ↑ Plasma levels

 

Narcotic (Opioid) Analgesics

E.g. Morphine, Codeine, Fentyl, Methadone, Pethidine, Naloxone

Mechanism: Agonists at opioid receptors (μ, κ, δ) in CNS → inhibit pain transmission
Effects: Analgesia, sedation, euphoria, respiratory depression

Indications - Opioids

• Severe acute/chronic pain
• Postoperative pain
• Cancer pain
• Antitussive (Codeine)
• Opioid addiction (Methadone)

Adverse Effects - Opioids

• Respiratory depression
• Constipation
• Nausea and vomiting
• Tolerance and dependence
• Miosis

 

Drug Interactions

• CNS Depressants (alcohol, benzodiazepines, antihistamines): Additive sedation & respiratory depression
• MAO Inhibitors (e.g., selegiline, isocarboxazid): Risk of serotonin syndrome or hypertensive crisis
• CYP450 Interactions: Drugs affecting CYP enzymes can alter metabolism of many opioids
• Serotonergic Drugs: Increased risk of serotonin syndrome (especially with tramadol, methadone, fentanyl)
• QT Prolonging Drugs: Important with methadone

Presentation for NSAIDs and Narcotic Analgesics

                                                                     END OF THE CHAPTER

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