How Do Prescription Non-Steroidal Anti-Inflammatories Work?

Non-steroidal, anti-inflammatory drugs (NSAIDs) are a category of drug administered to relieve pain and, especially in higher doses, reduce inflammation.

These drugs can be contrasted with glucocorticoid steroids, or corticosteroids, that reduce inflammation by binding to cortisol receptors.

Most people are familiar with non-prescription NSAIDs. Ibuprofen (Advil), naproxen sodium (Aleve), ketoprofen, and even aspirin can all be classified as NSAIDs.

There are less well known, stronger NSAIDs that require a physician's prescription. These are sold under brand names including Anaprox, Celebrex, Clinoril, Daypro, Disalcid, Feldene, Indocin, Lodine, Mobic, Naprelan, Naprosyn, Orudis, Relafen, and Toradol.

NSAIDs were observed to work before it was understood how they work. But over time, research has provided more information of what is going on in the body that enables NSAIDs to reduce inflammation.

Though there are all the many types of NSAIDs, they all work in similar ways.

NSAIDs interfere with the cyclo-oxyganase (COX) type of enzymes. Enzymes are protein-based molecules that either trigger or speed up specific chemical reactions in the body. COX enzymes control the production of prostaglandins.

Prostaglandins are hormone-like substances that serve many different functions. Among them are the causing of pain and inflammation, and the protection of the stomach from indigestion and ulcers.

NSAIDs interfere with the COX enzymes' production of the prostaglandin chemicals that cause inflammation. An undesired side effect of this, however, is that they can cause stomach irritation and problems by also inhibiting the production of the prostaglandin chemicals that protect the stomach lining.

More recently what are called COX-2 inhibitors have been developed. These NSAIDs are better at more narrowly targeting just the enzymes that produce prostaglandins that cause pain and inflammation, and leaving alone those that protect the stomach.

The COX-2 inhibitor NSAIDs succeed in reducing the side effect of indigestion and ulcers, however they have slightly worse side effects related to the heart.

So, broadly speaking, patients prone to stomach and intestinal problems are typically prescribed the COX-2 inhibitor NSAIDs, and patients with heart or circulatory issues are typically prescribed the standard NSAIDs.

NSAIDs and especially prescription NSAIDs clearly carry with them the risk of side effects, especially if taken long term, as well as issues of interactions with other drugs. Which, if any, is appropriate to take will vary from person to person and situation to situation. A physician should always be consulted for guidance about one's own specific situation.

Sources:

"NSAIDs (Nonsteroidal Anti-inflammatory Drugs) and Arthritis." WebMD.
"Prescription Nonsteroidal Anti-Inflammatory Medicines." Family Doctor.
"What Are NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)? What Are NSAIDs Used For?" Medical News Today.