Non-opioid analgesis

• Non-opioid analgesis

  NSAIDs

  Acetaminophen
• non-selective COX inhibitors ( traditional NSAIDs )

  • aspirin
  • ibuprofen
  • naproxen
  • diclofenac
  • ketorolac
  • mefanamic acid
• selective-cox2 inhibitors ( COXIB )

  • 1 generation : celecoxib
  • 2 generation : parecoxib, etoricoxib
• NSAIDS have anti platelet effect due to non selective cox inhibitors
• Selective cox 2 inhibitors have platelet aggregation
• Salicylate irritate to skin and mucosa. Destroy epithelial cells.
• NSAIDS should be used in the lowest effective dose for the shortest possible duration of treatment.
• Aspirin is contraindicated in children under 16 years old because it can cause Reye's syndrome
• Ibuprofen and naproxen are used in rheumatoid arthritis and osteoarthritis
• Ibuprofen is commonly used as it is equipotent to aspirin and lower GI side effect with low dose
• Ibuprofen and naproxen can interfere Aspirin's anti platelet effect because they compete with aspirin for binding sites
• At risk of cardiovascular complications, naproxen is recommended as NSAIDs
• Diclofenac sodium 


  • Commonly used
  • Similar efficacy to naproxen
  • High cardiovascular risk
• Ketorolac 


  • Mainly used as analgesic
  • Not as anti-inflammatory
• Tolmetin is not effective for gout
• Mefanamic acid 


  • Analgesic, anti-inflammatory, antipyretic
• Side effect of mefanamic acid is diarrhoea and renal failure in elderly patients
• Celecoxib is not first choice of NSAIDs
• Celecoxib is sulphonamide derivative
• Acetaminophen ( paracetamol ) is over the counter drug
• Paracetamol doesn't have anti-inflammatory action
• Paracetamol 's antipyretic action is due to inhibition of prostaglandins in hypothalamus and analgesic effect is due to inhibition of cox 3 in CNS
• Use as substitute for Aspirin in some cases
• Paracetamol is first line agent
• NSAIDs are used in acute arthritis
• DMARDs are used in acute arthritis
• DMARDs stand for disease modifying anti rheumatid drug
• Leflunomide is alternative to methotrexate
• Leflunomide is first line management of RA
• Adverse effect of leflunomide is diarrhoea
• Since leflunomide is teratogenic, it's use is contraindicated in pregnancy