Over the counter (OTC) painkillers
OTC painkillers used for pain relief in hypertensive patients mainly include acetaminophen and aspirin. You should not take ibuprofen, ketoprofen or naproxen sodium/potassium before consulting with a registered medical practitioner or registered pharmacist. 1
Prescription-only Medicine (POM), anti-inflammatory drugs with a combination of opiate analgesics
If you want to take steroidal anti-inflammatory drugs like cortisone or hydrocortisone, you must have a prescription from your psychiatrist. This also goes for non-steroidal drugs such as acetaminophen or ketoprofen with a combination of opiate analgesics like codeine, morphine, and oxycodone.
What are anti-inflammatory drugs?
Anti-inflammatory drugs reduce pain, inflammation, and fever. These drugs are used for a variety of injuries, inflammations, infections and health conditions like arthritis.
Types of anti-inflammatory drugs
Figure: Types of Anti-inflammatory Drugs
Created By Aastha Malik
There are two types of anti-inflammatory drugs.
Steroidal anti-inflammatory drug
These drugs are used to treat a variety of inflammations and infections and are usually known as corticosteroids. Sometimes, people are confused between steroidal drugs and Anabolic Steroids (AS). Anabolic steroids are prescription-only medicines that are prescribed for gaining muscle mass and physical strength.3
There are two other types of Corticosteroids.
These are involved in protein and carbohydrate metabolism and have anti-inflammatory activity. An example of a glucocorticoid is hydrocortisone.
Mineralocorticoids are involved in the regulation of minerals and are involved in circadian rhythm. 4
Non- steroidal Anti-inflammatory Drugs (NSAIDs)
These drugs are used to reduce fever, inflammation, and pain similarly to steroidal anti-inflammatory drugs. There are different types of NSAIDs depending on their selectivity and structure:
Non-selective NSAIDs mainly include Diclofenac sodium and potassium, ibuprofen, ketoprofen, acetaminophen, aspirin, piroxicam and meloxicam.
Celecoxib and rofecoxib are selective NSAIDs.5
Anti-inflammatory drugs and high blood pressure
Anti-inflammatory drugs are popular medications for pain relief. As discussed previously, there are two types of anti-inflammatory drugs; one is steroidal and the other is non-steroidal. Glucocorticoids, which are used as anti-inflammatory agents, belong to the steroidal anti-inflammatory drugs.
Studies have shown that glucocorticoid receptors are expressed throughout the body mainly in the kidney and brain. They have clinical significance in the induction of glucocorticoid-induced hypertension (high blood pressure).
Glucocorticoids are widely used to treat autoimmune diseases, rheumatoid arthritis, and other demyelinating diseases of the nervous system.
Effect on Cardiovascular Health
GCs can cause ischemic heart disease (IHD) and heart failure (HF). Atrial Fibrillation and flutter are also caused due to GCs. Prednisone is a GC and it causes fluid retention even with low doses and causes high blood pressure and other cardiovascular complications.
Consideration while GCs Therapy
The following considerations should be made when starting GCs therapy:
- Smoking should be prevented, and,
- Patients should regularly exercise and be vigilant about weight gain, which can result in high blood pressure and other cardiovascular risks.
- Minimum alcohol intake, necessarily less than 2 drinks per day.
- Go for a diabetes screening, as usually diabetes mellitus and cardiovascular anomalies come together.
- Baseline vitamin D should be focused on.6
Nonsteroidal anti-inflammatory drugs are widely used as minor to major pain relievers. A few studies are available that show the correlation between NSAIDs and high blood pressure, These studies suggest that there is a link between high blood pressure and NSAIDs intake. NSAIDs inhibit Prostaglandin formation and cause alteration in arteriolar smooth muscles and natriuresis.5
How do anti-inflammatory drugs work?
As there are mainly two types of anti-inflammatory drugs, their mechanism is described as follows:
Mechanism of action of GCs
These drugs cause the inhibition of B & T lymphocytes and phagocytes. These immune modulators play a major part in innate and acquired immunity. Hence, GCs affect autoimmune and auto-inflammatory disorders. These drugs act on cells in both genomic and non-genomic mechanisms. They block pro-inflammatory molecules; this mechanism is known as transrepression.GCs also stimulate anti-inflammatory molecules, which is known as transactivation. Transrepression is mainly involved in attaining desired effects and transactivation results in some side effects.
Mechanism of action of NSAIDs
NSAIDs act on cyclooxygenase enzymes and inhibit them. The cyclooxygenase enzyme is required to convert arachidonic acid into eicosanoids including thromboxane, prostacyclin, and prostaglandins. These eicosanoids are responsible for all inflammatory and immune responses. By acting on these targets, NSAIDs are anti-inflammatory, antipyretic and analgesic.7
Safe anti-inflammatory drugs
Always consult your registered medical practitioner or registered pharmacist before taking any kind of medication. Acetaminophen and aspirin are considered the safest OTC drugs. If the liver enzyme levels in your blood are elevated, then take acetaminophen with care. Aspirin should be taken cautiously with other blood thinning agents like warfarin. Glucocorticoids like prednisone, dexamethasone, hydrocortisone, and cortisone are not OTC drugs. GCs are prescription-only medicines.
Benefits
There are several advantages of taking anti-inflammatory drugs. They reduce inflammation and work as painkillers; hence, they aid in patients’ quality of life. NSAIDs gels and creams are available at the pharmacies. They are easy to use and can be applied to the skin.
Side effects and risks
Like all medicines, NSAIDs have also been known to cause side effects. Common side effects caused by the NSAIDs are as follow:
- Indigestion
- Stomach ulcers
- Drowsiness
- Allergic reactions
- Risk of cardiovascular diseases like heart failure, heart attack, and strokes.
- Sometimes they disturb liver and renal functions.
Interactions with other medicines
The following measures should be taken to avoid incidents while taking anti-inflammatory drugs.
- With other NSAIDs of the same or different class.
- Aspirin with warfarin
- Ciclosporin, this drug is used to treat autoimmune diseases and interacts with NSAIDs.
- Diuretics like spironolactone, acetazolamide, chlorthalidone and mannitol are mainly included in the risk of interactions with NSAIDs.
- NSAIDs interact with lithium. Lithium is a drug used in the treatment of bipolar depression.
- Serotonin Reuptake Inhibitors (SSRIs) used to treat depression are well-known agents to interact with NSAIDs, especially citalopram and fluoxetine.
Effects of overdose
NSAIDs overdose causes toxicity and outcomes such as:
Other options for anti-inflammatory drugs
Sometimes for minor inflammation, some antiallergic medication can be taken. However, paracetamol (Acetaminophen) can also be taken, which is available as an OTC.
Summary
Anti-inflammatory drugs can be taken according to the doctor's advice. While taking these drugs, the current condition of the disease must be considered. Over the counter (OTC) NSAIDs are available at pharmacies. POM medicine must be purchased after consulting a registered medical practitioner. All drugs must be kept out of the reach of children. In case of an overdose or adverse effects, call or contact your area’s emergency number.
Frequently Asked Questions
Can I use any painkiller available to me?
You can use it if it is over-the-counter medicine like paracetamol and must be cautious about the dose. If you already have taken painkillers and are not relieved from the pain, then contact your doctor.
What should I do in case of NSAID overdose?
Contact your nearest emergency centre for toxicity management.
If NSAIDs cause addiction?
Physical dependency can be caused by taking some NSAIDs. Taking paracetamol or ibuprofen combined with caffeine can cause physical dependency.
References
- InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG), 2006-. Using medication: The safe use of over-the-counter painkillers. 2017 2016 Apr 6 [Updated].
- Sobczak Ł, Goryński K. Pharmacological aspects of over-the-counter opioid drugs misuse. Molecules 2020;25(17):3905.
- Sinniah A, Yazid S, Flower RJ. From NSAIDs to Glucocorticoids and Beyond. Cells 2021;10(12).
- Gensler LS. Glucocorticoids: complications to anticipate and prevent. The Neurohospitalist 2013;3(2):92-97.
- Ghlichloo I GV. Nonsteroidal Anti-inflammatory Drugs (NSAIDs). 2022 Jan ([Updated 2021 May 12]. In: Stat Pearls [Internet]. Treasure Island (FL): StatPearls).
- Goodwin JE, Geller DS. Glucocorticoid-induced hypertension. Pediatric Nephrology 2012;27(7):1059-1066.
- Vane JR, Botting RM. Mechanism of action of nonsteroidal anti-inflammatory drugs. Am J Med 1998;104(3S1):2S-8S.
- Smolinske SC, Hall AH, Vandenberg SA, Spoerke DG, McBride PV. Toxic effects of nonsteroidal anti-inflammatory drugs in overdose. An overview of recent evidence on clinical effects and dose-response relationships. Drug Saf 1990;5(4):252-274.