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→Side Effects and Contraindications
Prostaglandins also have a vasodilatory action, and so local production in the kidney is important for maintaining normal renal perfusion. NSAID interference will therefore lower renal blood flow, giving rise to '''nephrotoxicity''', and so use in renal patients must be carefully considered. Care must also be taken when administering these drugs peri-operatively.
Prostaglandins have a vasodilatory action, and so local production in the kidney is important for maintaining normal renal perfusion. NSAID interference will therefore lower renal blood flow, giving rise to '''nephrotoxicity''', and so use in renal patients must be carefully considered. Care must also be taken when administering these drugs peri-operatively.
Some NSAIDs, such as aspirin and ketoprofen, can also have '''negative effects on coagulation'''. Platelet aggregation is caused by prostaglandins and thromboxanes which are produced by platelets using a COX-1 pathway. Inhibition of this pathway can therefore cause bleeding.
Because of these issues, the use of COX-2 selective drugs is desirable. These inclue [[NSAIDs#Carprfden|carprofen]], [[NSAIDs#Meloxicam|meloxicam]] and nimesulide.
===Drug Interactions===
The concurrent use of two COX inhibitors will result in both additive efficacy and toxicity.
NSAIDs used with cimetidine or chloramphencicol may be subject to slower metabolism. This is because these drugs inhibit mixed function oxidases (MFOs) in the liver.
As mentioned under [[NSAIDs#Pharmacokinetic Considerations|pharmacokinetics]], displacement of NSAIDs from their plasma protein binding with other high affinity drugs such as warfarin may lead to toxicity.
==Drugs in This Group==
==Drugs in This Group==