Non-steroidal anti-inflammatory drugs,

Mechanism of action

NSAIDs work by inhibiting the activity of cyclooxygenase enzymes (COX-1 and/or COX-2) thus reducing the production of key mediators involved in inflammation such as prostaglandins. They also have an antipyretic action as prostaglandin E2 is involved in the thermoregulation centre in the hypothalamus.


In general, NSAIDs are used in the management of pain.

Specific indications include:

Adverse effects

Important and common side-effects
  • Peptic ulceration
    • the risk may be reduced by co-prescription of a proton pump inhibitor (PPI). Typicaly indications for co-prescription include:
    • age >= 65 years
    • history of peptic ulcer disease
    • high-dose NSAID regime
    • used in combination with anticoagulants or other drugs that increase the risk of peptic ulcers e.g. SSRIs, corticosteroids, bisphosphonates
  • Exacerbation of asthma