Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly used OTC (over-the-counter) drugs in America. They differ in potency and duration of action. They also differ in their tendency to cause ulcers and bleeding based on their relative inhibition of COX-1 and COX-2.
Cyclooxygenase (COX) is an enzyme that is responsible for the formation of prostanoids. The three main groups of prostanoids – prostaglandins, prostacyclins, and thromboxanes – are each involved in the inflammatory response.
However, some of these chemical groups, especially the prostaglandins, produce anti-inflammatory compounds as well. The omega 3 fatty acids (like fish and flax seed oil) are used to make PG-3 (prostaglandin 3) which is anti-inflammatory and the omega 6 fatty acids (like evening primrose and black current seed oil) make the PG-1 series, also anti-inflammatory.
So while reducing inflammatory compounds that produce pain, NSAIDs also reduce the anti-inflammatory compounds that provide relief. These anti-inflammatory compounds also protect and maintain the lining of the GI tract, protect the liver, heart, and other tissues of the body.
Traditional NSAIDs are considered “nonselective” because they inhibit both COX-1 and Cox-2. It is the COX-1 inhibition that is associated with most of the side effects. Bleeding, ulcers, and perforation of the stomach or intestine can occur at any time without warning. Aspirin and Advil (ibuprofen) are the most common “nonselective” NSAIDs.
Celebrex (Aleve) was the first selective COX-2 inhibitor introduced in the late 1990s. Subsequent COX-2 inhibitors Vioxx and Bextra were removed from the market when it was discovered that COX-2 inhibitors are associated with an increased risk of heart attack. Two other COX-2 inhibitors Arcoxia and Prexige have so far been rejected by the FDA. Celebrex remains as the only COX-2 inhibitor available in the United States.
