THE NON-OPIOID ANALGESICS: NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS)
The NSAIDs commonly used in palliative care are the acetates, propionates and oxicams. Ketorolac is included as it is the only NSAID available as both a tablet and injection. The fenomate drug, mefenamic acid, is not recommended as it frequently causes diarrhoea.
The indications and mechanism of action are similar to aspirin. Doses vary for the different drugs and preparations. There is considerable variation in efficacy and toxicity between patients, and the dose must be individually titrated. In all cases the lowest effective dose should be used. Treatment for several days is required to achieve stable plasma levels and maximal effect.
Gastrointestinal-Studies in patients with rheumatic disorders suggest the frequency of gastrointestinal toxicity is less than with the equivalent dose of aspirin.
Haemostasis-NSAID-induced platelet dysfunction resolves within one to a few days of stopping the drug.
Renal-NSAIDs may cause sodium and fluid retention and can worsen pre-existing renal impairment. Interstitial nephritis is reported, usually after prolonged use.
Hypersensitivity. Hypersensitivity or allergic reactions may occur in patients who have demonstrated hypersensitivity to aspirin or another NSAID.
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