Often we use the drug that we have at home or the one we took last time. But it is wrong, because various variables must be taken into account on a case-by-case basis
One is not the same as the other: non-steroidal anti-inflammatory drugs, the so-called NSAIDs, are not all the same or interchangeable. We keep a supply of them in our medicine cabinet and take them in a myriad of situations, when we have a headache or back pain, if we have a toothache or if we have caught the flu, without paying too much attention to it. that we choose, without asking your doctor or pharmacist for advice and often opting for one or two active ingredients that we think are all-rounders. Nothing could be more wrong, as the experts who spoke during the recent Corriere Salute Antiinflammatory meeting underlined: what to ask your doctor before taking them.
What kind of action do they have
Despite the ease with which we use them, Fans deserve a lot more attention from us. These drugs are like a forest that, seen from afar, is an indistinct green, but if we get closer it is full of very different trees, summarizes the pharmacologist Francis Scaglionedirector of the Structure of Chemical-Clinical Analysis and Microbiology Asst Niguarda of Milan. All Fans act like
anti-inflammatories, painkillers and antipyretics because they inhibit two enzymes, cyclooxygenase (or Cox) 1 and 2; Cox1 is an essential enzyme also involved in the functioning of the stomach, kidneys and platelets, while Cox2 is induced, or expressed, when there is inflammation. Fans therefore have to inhibit Cox 2. However, if they are too “selective”, we will have, for example, fewer stomach problems, but if, due to their action, they leave Cox 1 too “free”, the platelets could aggregate too much and this can create cardiovascular problems for the formation of thrombi.
Different actions
Each of the NSAIDs has a different action profile on the two Cox enzymes, which in some cases changes with the dosage: for example, a drug that has a marked anti-Cox1 function at low doses can be useful as an antiplatelet agent if taken in minimal quantities, but be used as an anti-inflammatory if the dosage goes up and so Cox2 also becomes its target. All this modifies the effect of the various drugs but as you observe Claudio Cricelli, president of the Italian Society of General Medicine and Primary Care, it is difficult for patients to know that there are painkillers without an anti-inflammatory effect, non-anti-inflammatory anti-febrile drugs, others that combine several actions together; above all, they cannot distinguish them. Furthermore, the active ingredients of NSAIDs are often found in over-the-counter products that combine other molecules for a more effective treatment, for example, of cooling symptoms: there is a real risk of taking more than one NSAID together without realizing it.
Side effects
The consequence is a greater probability of meeting the side effects such as gastrointestinal upset or kidney or liver damage, which are more frequent in those who already suffer from diseases involving these organs and systems. Also for this reason, as Scaglione advises, before taking an anti-inflammatory you should seek advice from your doctor or pharmacist, informing him of your health conditions in order to choose the most suitable product for you. These drugs are not interchangeable, also because pharmaceutical technology has helped to create different formulations of the same active ingredients, with different characteristics and actions: a careful choice can greatly reduce the danger of adverse events.
Prevention
The prevention of side effects is an essential element to take into account: Before taking a NSAID you should always ask yourself if the possible adverse events are compatible with your state of health: if you are elderly or have gastrointestinal, renal, cardiovascular, hepatic caution is even more necessary, Cricelli points out. The first question to ask yourself, however, is whether you really need to take a medicine: in the majority of cases NSAIDs are taken to manage the passing symptoms of a disorder, doing so or not derives from having evaluated the balance between relieving discomfort and exposing oneself to side effects, taking into account the specific efficacy of the product in the situation in which it is to be used. Last but not least, the duration of the therapy counts: self-medicated NSAIDs should be used for a few days, the time to eliminate the symptom. And also in the use in chronic diseases such as osteoarticular diseases (for example osteoarthritis of the knee, ndr)
always on medical indications, short cycles are envisaged which almost never exceed three or four weeks of treatment, concludes Cricelli.
A useful reaction to stop when too much
The inflammation is a two-faced Janus. It is a fundamental mechanism for our life, because it turns on to protect us from infections and more: when something threatens us, the first reaction is always to bring inflammatory molecules and cells into the field to contain the danger. Sometimes the inflammation takes over and becomes negative. in these situations it becomes necessary to intervene with drugs, as he explains Massimo Andreonipresident of the Italian Society of Infectious and Tropical Diseases: We must respect inflammation as long as it is physiologicalbut if it becomes exaggerated it must be blocked or reduced to prevent a harmful vicious circle from being triggered, which the body is unable to stop and becomes a tsunami that overwhelms everything. the case of sepsiswhen an infection, but above all the inflammation it generates, spreads throughout the body leading to death. And the case of Covidwhich we infectious disease specialists today consider a case of sepsis: when the body reacts too much to the virus, the resulting uncontrolled cytokine and inflammatory cascade is responsible for the sometimes fatal multi-organ failure.
More complex cases
Any infection must always be stopped with Fans then? It depends on the extent of the infectious process, but if, for example, an airway infection which at the beginning is a “simple” pneumonia causes breathing difficulties, it means that an inflammation is “mounting” which can become harmful and must be blocked or slowed down, explains Andreoni. And good to notice soonbecause once an inflammatory cascade is triggered it becomes difficult to stop it: in the past we tended to use antipyretics first and then anti-inflammatories, now the attitude has changed and it is understood that inflammation must be managed, even before fever. In these more complex cases, the prescription of NSAIDs is necessarily entrusted to the doctor, whose intervention is indispensable whenever these drugs are used not only to alleviate the symptoms of a disorder but to influence its causes and course: NSAIDs can be prescribed to regulate the inflammatory mechanisms that are damaging the body, for example they can be given to control platelet aggregation in those with a high risk of thrombosis; in these cases the use goes beyond the reduction of symptoms, but blocks a mechanism that is becoming negative for the patient, concludes Andreoni.
Fever doesn’t always go down
One of the situations in which Fans are most often used is fever. Having said that even in this case not all drugs are the same, because some have a predominantly antipyretic effect while others are less effective on fever and more on pain or inflammation, do you always need the pill when the temperature rises? No, because fever is a defense mechanism: many viruses, for example, live badly at 38 or 39 degrees and raising the internal temperature facilitates their elimination, replies Massimo Andreoni. In some cases, the fever can become harmful: in those with heart or respiratory failure, increased oxygen requirements due to fever can create difficulties, in some children a high fever can lead to febrile convulsions. The use of antipyretics requires a fair compromise, in order not to nip a useful tool in the bud, but without letting it become harmful.
April 13, 2023 (change April 13, 2023 | 06:52)
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