Ranking of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) based on potency, from strongest to weakest:

Ranking of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) According to Potency

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) are a diverse group of medications commonly used to treat pain, inflammation, and fever. They are categorised into two main types: non-selective NSAIDs and COX-2 selective NSAIDs, based on their inhibition of cyclooxygenase enzymes (COX).

Non-selective NSAIDs inhibit both COX-1 and COX-2 enzymes. COX-1 plays a role in maintaining the integrity of the stomach lining and platelet function, while COX-2 primarily mediates inflammation and pain. Examples of non-selective NSAIDs include aspirin, ibuprofen, naproxen, diclofenac, and indomethacin. These drugs reduce inflammation but may cause gastrointestinal side effects due to COX-1 inhibition.

On the other hand, COX-2 selective NSAIDs preferentially inhibit the COX-2 enzyme, aiming to reduce inflammation and pain while minimising gastrointestinal side effects. Celecoxib is a common COX-2 selective NSAID.

Roles in the body:

COX-1 inhibition: Can lead to reduced protective prostaglandins in the stomach and kidneys, potentially causing gastrointestinal irritation or bleeding. Aspirin, for example, is known for its blood-thinning effect due to its inhibition of platelet aggregation.
COX-2 inhibition: Primarily reduces prostaglandins responsible for inflammation, pain, and fever, providing the anti-inflammatory and analgesic effects typical of NSAIDs.

NSAIDs are further classified by their chemical structure, including salicylates (aspirin and related compounds), propionic acid derivatives (ibuprofen, naproxen), acetic acid derivatives (diclofenac, indomethacin, ketorolac), and others based on chemical differences. This classification helps guide the choice of NSAID based on desired effects and side effect profiles in clinical use.

Some NSAIDs are available over-the-counter (OTC), such as ibuprofen and naproxen, while others require a prescription. For OTC ibuprofen, the typical dose for adults and children over 12 is 200 milligrams (mg) every 4 to 6 hours, or 400 mg if that does not work. Naproxen comes in several doses, including 250 mg, 375 mg, and 500 mg. A typical dosage for adults is one to two 220 mg tablets every 12 hours.

It is essential to discuss any medications a person already takes with a doctor before trying a new NSAID. This is because NSAIDs can interact negatively with several other medications, such as other NSAIDs, warfarin, lithium, diuretics, selective serotonin reuptake inhibitors, methotrexate, ciclosporine, and more.

Certain people should avoid NSAID use, such as those with kidney disease or stomach ulcers. Rarely, children recovering from chickenpox or who have flu-like symptoms develop a serious condition known as Reye's syndrome after taking aspirin.

Well-known brand-name carriers of ibuprofen include Advil and Motrin, while Aleve is a well-known type of naproxen. Aspirin is available only in OTC form and comes in several different formulas and doses, such as slow-release 81 mg tablets or regular strength tablets.

Remember, the safety and effectiveness of NSAIDs can vary among individuals, and it's always crucial to follow a doctor's advice when using these medications. If you have any concerns or questions, consult your healthcare provider.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3425539/ [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3425538/ [3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4203638/ [4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4203637/ [5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4203636/

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