Nonsteroidal Anti-inflammatory Drugs

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Abstract
Over the past decade, many new nonsalicylate, nonsteroidal anti-inflammatory drugs (NSAIDs) have been introduced in the United States. These include fenoprofen, ibuprofen, meclofenamate, naproxen, piroxicam, sulindac, and tolmetin in addition to indomethacin and phenylbutazone, which were previously available. These drugs have added to our therapeutic armamentarium for management of degenerative joint disease (DJD) and rheumatoid arthritis (RA) as well as other rheumatic and nonrheumatic disorders. CLASSIFICATION AND CLINICAL PHARMACOLOGY Figure 1 provides a chemical classification of currently available NSAIDs. Although these groupings do not hold notable clinical relevance, differences among the classes may be unveiled as we gain more understanding of their pharmacologic activity. All NSAIDs are rapidly absorbed and highly protein bound with peak serum levels occurring within four hours after ingestion. Half-life varies from two to 50 hours with excretion via urine, bile, and feces as inactive metabolites, with less than 10% excreted unchanged. At pharmacologic doses, NSAIDs