These are drugs which suppress inflammation but are not corticosteroids (see Section 5). They work by reducing the quantities of prostaglandins (p28) produced by the body. Their main use is in rheumatoid arthritis where they can reduce the pain and swelling in the joints.

The NSAID that everyone knows is aspirin, which belongs to a group of drugs called salicylates. There are many other NSAIDs, and they are very varied chemically, the only common factor being their effect on prostaglandin synthesis.

Because prostaglandins do a variety of different jobs in the body, a drug that interferes with their production is likely to have side-effects. In particular, prostaglandins play an important role in the stomach, and NSAIDs tend to cause stomach upsets, or more serious damage to the stomach lining. Aspirin is the worst offender in this respect. Various modified forms of aspirin have been introduced in an effort to reduce its side-effects on the stomach. But these may still affect the stomach, and should not be taken by anyone who has ever had a stomach ulcer. Asp/r/n-containing drugs are listed in the next section.

Prostaglandins also play an important role in the kidney, and some NSAIDs affect kidney function causing water retention (oedema). Long-term use of NSAIDs, without proper supervision, can lead to kidney damage, but this is rare.

Some people appear to be particularly sensitive to aspirin (see p55) and may suffer from asthma or urticaria as a result. Some of these people react in a similar way to other NSAIDs, and some may be affected by paracetamol as well. There are other painkillers, available on prescription, that are suitable for such patients.

7 A Drugs used for rheumatoid arthritis containing aspirin and other salicylates

aloxiprin (Palaprin)

aspirin (Anadin, Caprin, Claradin, Nu-

Seals, Paynocil, Solprin) benorylate (Benoral) diflunisal (Dolobid) salsalate (Disalcid)

choline magnesium trisalicylate (Trilisate)

7B Propionic acid derivatives

Another important group of NSAIDs are the propionic acid derivatives. These do not reduce inflammation quite as well as aspirin, but they are effective pain-killers and cause far fewer problems in the stomach than aspirin. However, some patients may suffer from stomach upsets or rashes, and some of the drugs can also cause headaches, drowsiness and other minor problems. These drugs are generally used for mild forms of rheumatoid arthritis, where the inflammation is not very great. They include:

ibuprofen (Apsifen, Brufen, Ebufac, Fenbid Spansule, Lidifen, Motrin, Paxofen)

fenbufen (Lederfen)

fenoprofen (Fenopron, Progesic)

flurbiprofen (Froben)

ketoprofen (Alrheumat, Orudis, Oruvail)

naproxen (Laraflex, Naprosyn, Synflex)

tiaprofenic acid (Surgam)

Mefenamic acid (Ponstan) is a similar drug whose main value is in relieving pain. It can cause diarrhoea or rashes, and is not generally given to elderly patients.

*434\180\8*

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