[The non-steroidal anti-inflammatory drugs]

The non-steroidal anti-inflammatory drugs (NSAIDs) are a chemically heterogenous group of organic acids which possess analgesic, antipiretic, and anti-inflammatory action. They act by inhibiting the biosynthesis of the ubiquitous chemical mediators prostaglandins, but other mechanism of action are probably important. More than one hundred NSAIDs have been studied and many of them have been marketed worldwide, in many different formulations. Pharmacokinetic characteristics are different with various compounds and some of these differences may be relevant for the efficacy/safety profile of some of these drugs. The range of clinical applications of NSAIDs has been extended remarkably as a result of the recognition of their action on ubiquitous prostaglandins. In general NSAIDs therapeutic efficacy is similar and probably not superior to that of aspirin. Although the risk of serious toxicity from the newer NSAIDs is reasonably low in individual patients, the high prevalence of usage of these drugs, especially in the elderly, gives perception of a high relative risk. A high level of vigilance for toxicity, especially that of the gastrointestinal tract and the kidney, seems wise. The basis for the selection and rational use of NSAIDs is reviewed.