NSAIDs - non-steroidal anti-inflammatories
How NSAIDs Work
NSAIDs work by preventing an enzyme (a protein that triggers changes in the body) from doing its job. The enzyme is called cyclooxygenase, or COX, and it has two forms. COX-1 protects the stomach lining from harsh acids and digestive chemicals. It also helps maintain kidney function. COX-2 is produced when joints are injured or inflamed.
COX-1 and COX-2 enzymes play a key role in making prostaglandins, which cause pain and swelling by irritating your nerve endings. By blocking the COX enzymes, NSAIDs essentially stop your body from making too much prostaglandin, and therefore reduce pain and swelling.
Advantages and Disadvantages of NSAIDs
NSAIDs produce fewer side effects when compared to opioids. After surgery, some medical personnel may recommend that the use of NSAIDs may reduce your need for opioid medications but there is no real or anecdotal evidence to support that premise. NSAIDs alone, however, will not relieve the moderate to severe pain you may have after surgery.
But it is true that NSAIDs do not have the same opioid side effects such constipation and drowsiness. NSAIDs also do not lead to addiction but can result in psychological dependence.
Traditional NSAIDs block the actions of both COX-1 and COX-2 enzymes, which is why they can cause stomach upset and bleeding, and are associated with ulcers. Aspirin and ibuprofen are common traditional NSAIDs amongst others!.
are a special category of NSAIDs. These medications target only the COX-2 enzyme that stimulates the inflammatory response. Because they do not block the actions of the COX-1 enzyme, these medications generally do not cause the kind of stomach problems that traditional NSAIDs do. COX-2 inhibitors, however, have possible cardiac side effects.
NSAIDs group includes:
marketed as Advil, Motron, Nurophen, Nuprin and others - maximum intake generally per 24 hrs is 3,200 mg
marketed as Aleve or Naproxyn - maximum intake per 24 hrs is 660 mg
naproxen has a slightly different action than ibuprofen but basically is much the same strength and effectiveness which is suitable for mild-moderate pain.
There are innumerable other meds in the NSAIDs group
(Anacin, Ascriptin, Bayer, Bufferin, Ecotrin, Excedrin)
Choline and magnesium salicylates (CMT, Tricosal, Trilisate)
Choline salicylate (Arthropan)
Diclofenac potassium (Cataflam)
sodium (Voltaren, Voltaren XR)
sodium with misoprostol (Arthrotec)
Etodolac (Lodine, Lodine XL)
Fenoprofen calcium (Nalfon)
(Advil, Motrin, Motrin IB, Nuprin)
(Indocin, Indocin SR)
Ketoprofen (Actron, Orudis, Orudis KT, Oruvail)
Magnesium salicylate (Arthritab, Bayer Select, Doan's Pills, Magan, Mobidin, Mobogesic)
Meclofenamate sodium (Meclomen)
Mefenamic acid (Ponstel)
Naproxen sodium (Aleve, Anaprox)
Salsalate (Amigesic, Anaflex 750, Disalcid, Marthritic, Mono-Gesic, Salflex, Salsitab)
Sodium salicylate (various generics)
Tolmetin sodium (Tolectin)
I often get muddled between Advil and Aleve so I always Google to check. Imagine my surprise to find this statement under the official Advil site
Nothing is proven stronger, or longer lasting on tough pain than Advil®.
This is such an exaggeration of the truth! They also say "The active ingredient (of Advil) is ibuprofen". But gram for gram, acetaminophen is roughly 40% stronger as a pain medication than any NSAIDs so long as it is taken appropriately which is 1,000mg per dose up to 4 times per 24hrs.
January 8, 2016 Edit to include:
Europe, including the UK, are currently taking the makers of Neurofen and similar products to task because of these untruthful claims, including the claims that products advertised to "target" areas such as headache, back pain, joint pain, menstrual pains, etc., etc. as they all have exactly the same ingredients! Moral being: don't believe adverts!
The Guardian UK
Monday 14 December 2015 00.51 GMT
Nurofen criticised by Australian consumer watchdog over misleading claims
Drug giant Reckitt Benckiser ordered to pull painkillers off Australian shelves after admitting products marketed for specific types of pain were identical. A court in Australia has ordered drug giant Reckitt Benckiser
to stop selling some of its popular Nurofen painkiller brands after finding tablets marketed for specific complaints such as back pain or migraines contained exactly the same active ingredient.
The Australian federal court ruled that the British-based multinational had made misleading claims when selling its Nurofen Back Pain, Nurofen Period Pain, Nurofen Migraine Pain and Nurofen Tension Headache products. While these were marketed as formulated to treat a specific type of pain, and cost about double the price of standard Nurofen, tablets from the so-called Nurofen Specific Pain range were all found to contain the same active ingredient, 342mg of ibuprofen lysine, equivalent to 200mg of ibuprofen.
The court ordered that the products should be removed from shops within three months. A subsequent court hearing will decide on a possible fine for the company.
The ruling followed legal action launched this year
by the Australian Competition and Consumer Commission (ACCC), which argued that even though the tablets all contained the same generic ingredient they were priced “significantly above that of other comparable analgesic products”. The ACCC’s chairman, Rod Sims, said
on Monday that the watchdog had been concerned people might have bought the products “in the belief that they specifically treated a certain type of pain, based on the representations on the packaging, when this was not the case”.
Sims said price sampling by the ACCC before the start of the court case found the Nurofen Specific Pain products were being sold at almost double that of Nurofen’s standard ibuprofen. He said: “Truth in advertising and consumer issues in the health and medical sectors are priority areas for the ACCC, to ensure that consumers are given accurate information when making their purchasing decisions. “Any representations which are difficult for a consumer to test will face greater scrutiny from the ACCC.”
The Nurofen brand is also used in the UK and New Zealand. While many of the same pain-specific Nurofen products are sold in Britain, and also all contain 342mg of ibuprofen lysine, the British government’s Medicines and Healthcare Products Regulatory Agency
(MHRA) said it currently had no concerns about the issue.
An MHRA spokeswoman said: “For over-the-counter medicines, informative names are permitted to help patients select an appropriate product without input from a healthcare professional.”
The MHRA has no remit on medicine pricing, and tends to intervene only when a product’s name or description makes a medically misleading claim. The Consumers’ Association in the UK said it had no comment to make as it had not looked at the issue.
Aomesh Bhatt, head of regulatory and medical affairs for Reckitt Benckiser in Europe, said the company did not set out to mislead consumers and was cooperating with the ACCC and the federal court. It was, he said, an “Australia-only issue” with no implications for UK sales.
Speaking on BBC Radio 4’s World at One
, Bhatt explained the company’s reasoning for branding the same ingredient under multiple names: “Consumers want the navigation in a grocery environment, where there’s no healthcare professional to assist in the decision-making. We know that 90% of consumers look for a specific type of product for their individual pain.”
The company has been ordered to publish website and newspaper articles to clarify its status, implement a consumer protection compliance programme and pay the ACCC’s costs. The company’s Australian website has already been changed. A section describing the four types of pill
connected to the case describes them as “for general pain” and says: “Any of the four products shown on this page have the same ingredient and can be taken to provide effective temporary relief of pain and/or inflammation associated with either migraine, tension headache, back pain or period pain.”