Uses and Effects of NSAIDs - Differences in anti-inflammatory activity between NSAIDs are small - Individual patient response and tolerance to NSAIDs vary - About 60% of patients will respond to any NSAID - Pain relief starts soon after taking the first dose - Full analgesic effect should normally be obtained within a week - NSAIDs may help reduce post-operative pain - Starting NSAID painkiller medications before surgery may be beneficial - The risk of surgical bleeding and other complications is not well studied - Combining NSAIDs with paracetamol may improve pain relief - High-quality randomised controlled trials are needed for more conclusive evidence - Aspirin irreversibly inhibits COX-1 - It is indicated for antithrombosis and prevention of cardiovascular events - Aspirin inhibits platelet aggregation by blocking thromboxane A - Useful for managing arterial thrombosis and heart attacks - Aspirin has unique properties compared to other NSAIDs - NSAIDs are useful for managing post-operative dental pain - They are favored over paracetamol alone due to their anti-inflammatory effect - Pre-operative analgesia may reduce post-operative pain associated with orthodontic spacers - Adverse effects of NSAIDs are becoming increasingly common - NSAIDs may increase the risk of kidney complications and gastrointestinal problems - COX-2 inhibitors should not be taken with traditional NSAIDs - Rofecoxib had fewer gastrointestinal adverse drug reactions compared to naproxen - Cardiovascular safety of COX-2 inhibitors raised concerns - Methotrexate can be safely used with NSAIDs in rheumatoid arthritis - Balancing the benefit-risk profile of NSAIDs is important in chronic musculoskeletal pain treatment

Adverse Effects and Risks - Long-term use of NSAIDs (over three months) associated with erectile dysfunction - A 2005 Finnish survey study found this association - A 2011 publication in The Journal of Urology received widespread publicity - Regular NSAID use significantly increases the risk of erectile dysfunction - Link between NSAID use and erectile dysfunction still exists after controlling for several conditions - NSAIDs directly and indirectly irritate the gastrointestinal (GI) tract - Inhibition of COX-1 and COX-2 reduces protective prostaglandins in the GI tract - Common gastrointestinal side effects include nausea, vomiting, indigestion, gastric ulceration or bleeding, and diarrhea - NSAID ulcers can occur irrespective of the route of administration and even in people with achlorhydria - Risk of ulceration increases with therapy duration and higher doses - NSAIDs should be used with caution in individuals with inflammatory bowel disease - They can cause gastric bleeding and ulceration in the gastric lining - NSAIDs have a high incidence of adverse drug reactions (ADRs) on the kidney - Changes in kidney blood flow lead to kidney ADRs - Prostaglandins help maintain normal kidney function, but NSAIDs block their effects - Common ADRs associated with altered kidney function include sodium and fluid retention and hypertension - NSAIDs may cause more severe kidney conditions such as interstitial nephritis and acute kidney injury - Photosensitivity is a commonly overlooked adverse effect of many NSAIDs - The 2-arylpropionic acids are most likely to produce photosensitivity reactions - Other NSAIDs like piroxicam, diclofenac, and benzydamine have also been implicated - Benoxaprofen, now withdrawn, was the most photoactive NSAID observed - The mechanism of photosensitivity involves the decarboxylation of the carboxylic acid moiety - NSAIDs are not recommended in the third trimester due to the risk of premature closure of the fetal ductus arteriosus and kidney ADRs in the fetus - NSAIDs are linked with premature birth and miscarriage - Aspirin can be used with heparin in pregnant women with antiphospholipid syndrome - Indomethacin can be used to treat polyhydramnios in pregnancy - Paracetamol (acetaminophen) is generally considered safe during pregnancy, but a study indicated a potential association with male infertility - Allergic or allergic-like NSAID hypersensitivity reactions occur after ingestion of NSAIDs - These reactions differ from toxicity reactions, which are dose-related and can occur in any treated individual - Allergic reactions include IgE-mediated urticarial skin eruptions, angioedema, and anaphylaxis - T cell-mediated delayed onset skin reactions can also occur, such as maculopapular rash and contact dermatitis - Severe and potentially life-threatening t-cell-mediated delayed systemic reactions can occur, such as DRESS syndrome and Stevens-Johnson syndrome - NSAIDs may delay healing from bone and soft tissue injuries by inhibiting inflammation - However, they might also speed recovery from soft tissue injuries by preventing inflammatory processes from damaging adjacent muscles - Moderate evidence suggests that NSAIDs delay bone healing - The overall effect on soft-tissue healing is unclear - Long-term use of NSAID analgesics and paracetamol is associated with an increased risk of hearing loss - The use of NSAIDs for analgesia following gastrointestinal surgery is controversial due to mixed evidence of increased risk of bowel anastomosis leakage - Common adverse drug reactions include raised liver enzymes, headache, and dizziness - Uncommon adverse drug reactions include high level of potassium in the blood, confusion, airway spasm, and rash - Ibuprofen may rarely cause irritable bowel syndrome symptoms - NSAIDs are implicated in some cases of Stevens-Johnson syndrome - NSAIDs reduce kidney blood flow and decrease the efficacy of diuretics - They inhibit the elimination of lithium and methotrexate - NSAIDs decrease the ability to form blood clots, increasing the risk of bleeding when combined with other drugs that also decrease blood clotting - NSAIDs may aggrav