Steroidal and non-steroidal anti-inflammatories (NSAIDs): We explain it all!

Anti-inflammatory drugs are divided into two categories: non-steroidal anti-inflammatory drugs (NSAIDs) and steroidal anti-inflammatory drugs. 

Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are available on prescription with the exception of a few molecules such as ibuprofen, aspirin or naproxen which are available over the counter. In all cases, they inhibit the formation of prostaglandins (a pro-inflammatory molecule). Thus, they have a role against inflammation. 

The main types of NSAIDs include:

• Ibuprofen (Nurofen®, Calprofen®)
• Naproxen (Stirlescent®, Naprosyn®)
• Diclofenac (Voltarol®)
• Celecoxib (Celebrex®)
• Mefenamic (Ponstan®)
• Etoricoxib (Arcoxia®)
• Indomethacin (Indocid®)
• High-dose aspirin®

What are the indications for the use of NSAIDs? 

NSAIDs are used to treat inflammation but also as analgesics (for pain) and antipyretics (for fever). Those sold over the counter are widely used for self-medication of pain and fever in seasonal conditions like cold and flu. NSAIDs are not, however, risk-free treatments. Indeed, even if some are available over the counter, they can cause serious side effects (allergy, kidney failure, etc.). 

However, their use does not stop there. They can be used in the treatment of inflammatory diseases such as rheumatoid arthritis or ankylosing spondylitis. They can also be used to treat severe acute pain such as renal colic (pain caused by dislodged kidney stones) or gout. 

Finally, they can be applied locally as creams or ointments to combat inflammation. 

What are the contraindications for the use of NSAIDs? 

NSAIDs have a few contraindications. These are common to all NSAIDs and include the following: 

• History of GI bleeding or perforation related to NSAID use,
• History of asthma or allergy after taking NSAIDs or aspirin,
• Stomach or duodenal ulcers, 
• Severe liver damage, 
• Severe heart or kidney failure, 
• Pregnancy, from the 6th month onward. 

Some NSAIDs have specific contraindications. For example, for diclofenac, aceclofenac and celecoxib, the patient must not have a history of myocardial infarction (heart attack), stroke, arteritis or angina. 

In addition, NSAIDs interact with many drugs, including blood thinners (aspirin, Xarelto®, etc), lithium, methotrexate, diuretics, ACE inhibitors and sartans (Angiotensin II receptor blockers or ARBs).

Finally, more than one NSAID should not be combined.

Steroidal anti-inflammatory drugs

Steroidal anti-inflammatory drugs or glucocorticoids (a type of corticosteroid) have an anti-inflammatory (in low doses) and immunosuppressive (in high doses) action. As a result, they are used in the treatment of inflammatory conditions such as rheumatoid arthritis or autoimmune diseases. Unlike NSAIDs, corticosteroids have no analgesic activity of their own (apart from the pain caused by the anti-inflammatory effect). 

They are only available on prescription.  

What are the contraindications for the use of glucocorticoids? 

There are several contraindications to this class of drugs. They are not recommended in the following cases: 

• Severe, uncontrolled mental illness 
• Active infection, 
• Recent vaccination with a live or live-attenuated vaccine. 

In addition, these drugs also have a number of drug interactions, namely: 

• Drugs that increase the risk of hypokalaemia (low potassium levels) such as hypokalaemic diuretics (furosemide), laxatives, etc; 
• Blood thinners and anti-platelet agents (risk of increasing the risk of haemorrhage.

They can be used throughout pregnancy if the illness necessitates it. However, they are considered doping agents and must be combined with PPIs (proton pump inhibitors) such as pantoprazole or omeprazole, for example, in the case of stomach ulcers.