ABSTRACT
If amiodarone is the riskiest drug prescribed in primary care (on specialist recommendation), then the NSAIDs come a close second. Fortunately, the causes of NSAID-induced adverse drug reactions (ADRs) and adverse drug interactions (ADIs) are relatively easy to explain and understand. NSAIDs block the synthesis within tissue cells of the pros-tanoid family of chemical messengers – the prostaglandins, prostacyclins and thromboxanes. The NSAIDs’ analgesic and antipyretic effects are due to blocking of neuronal prostaglandin synthesis, which sensitises peripheral pain receptors and spinal pain pathways, and synthesis of the prostaglandin in the temperature regulator of the hypothalamus, which initiates fever. Unfortunately, the NSAIDs block the synthesis of most of these essential regulators and so seriously disrupt organ function in a large proportion of patients, particularly the elderly and those with failing organs. NSAIDs also interact with several commonly prescribed maintenance regimes, either by reducing their efficacy or by adding to their unwanted side-effects.
