Clinical Uses of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and Potential Benefits of NSAIDs Modified-Release Preparations

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most widely used medications in the world. They act via inhibition of cyclooxygenase (COX) isoenzymes. The combined analgesic, anti-inflammatory, and antipyretic effects make NSAIDs especially useful for symptomatic relief of painful inflammatory conditions and fever. They are used for treating musculoskeletal disorders (chronic, like osteoarthritis and rheumatoid arthritis, and acute, like acute gout and injuries), headaches, dental and postoperative pain, and dysmenorrhea, and aspirin also for prevention of cardiovascular events. NSAIDs may cause serious gastrointestinal, cardiovascular, and renal adverse effects, which may be prevented by performing risk assessments for each patient, choosing a NSAID with low risk for the particular side effect, and limiting its dosage and treatment duration. Gastroprotective agents are recommended for gastroduodenal ulcers prevention. Topical NSAIDs application offers a possibility for minimization of all systemic NSAIDs side effects, as well as drug-drug interactions. Evidence supports topical NSAIDs use in hands and knees osteoarthritis, and probably also in acute musculoskeletal pain. They can cause local skin irritation. Modified-release oral preparations improve patient compliance, and are especially important for short-acting NSAIDs. Topical modified-release preparations could improve efficacy and tolerability of NSAIDs topical treatment, and patient compliance