Overview of NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) include nonselective cyclo-oxygenase (COX) inhibitors and COX-2–selective inhibitors (the latter group is sometimes referred to as coxibs). NSAIDs commonly used in dentistry shows NSAIDs commonly used in dentistry.

Table 1. NSAIDs commonly used in dentistry
NSAID	Frequency of oral administration [NB1]
nonselective
ibuprofen	3 or 4 doses daily
naproxen	1 or 2 doses daily [NB2]
COX-2 selective
celecoxib	1 or 2 doses daily
Note: NSAID = nonsteroidal anti-inflammatory drug; COX = cyclo-oxygenase NB1: The frequency of administration gives an indication of the drug's half-life (eg ibuprofen has a short half-life so requires frequent dosing). NB2: Immediate-release naproxen is dosed twice daily and modified-release naproxen is dosed once daily.

NSAIDs are the preferred drug class for acute dental pain; however, they can cause significant renal, cardiovascular, gastrointestinal, respiratory and haematological adverse effects—these are summarised in Major adverse effects of NSAIDs.

Note: The risk of harm from NSAIDs increases with increasing age, higher doses, longer durations of treatment, and concomitant use of some drugs.

Table 2. Major adverse effects of NSAIDs
System	Adverse effects
renal	impaired kidney function, acute kidney failure
cardiovascular	increased blood pressure, fluid retention, worsening of heart failure, thrombosis, myocardial infarction, stroke, cardiovascular death
gastrointestinal	oesophageal, gastric, duodenal and small bowel ulceration, upper abdominal pain, gastric erosions, gastrointestinal bleeding
respiratory	bronchospasm in patients with NSAID-exacerbated respiratory disease [NB1]
haematological	impaired platelet function [NB1]
Note: NSAID = nonsteroidal anti-inflammatory drug NB1: This adverse effect occurs with nonselective NSAIDs, but not COX-2–selective NSAIDs.