…continued

Other NSAIDs

Over 20 different compounds have been developed to perform the beneficial functions of aspirin without some of the negative side effects. Ibuprofen (Motrin, Advil) and Naproxen (Naprosyn) fall into this category. They are used to treat pain, swelling and fever, but have fewer side effects on platelet aggregation and clotting. In addition, some of the aspirin derivatives have been modified so they have an extended duration of effectiveness. In contrast, aspirin is metabolized and excreted by the body in four to six hours at which point you have to take another dose.

Cox-2 specific inhibitors

More recently, researchers have developed specific inhibitors of cyclooxygenase-2. COX-2 plays a primary role in producing prostaglandins in response to injury or tissue stress whereas COX-1 is found in many tissues and can have good functions. Aspirin inhibits both COX-1 and COX-2 so specific inhibitors for COX-2 should block inflammation, pain and fever without affecting prostaglandin synthesis by COX-1. Currently, Cerebrex and Vioxx are on the market. In theory these should have fewer side effects and not be upsetting to the stomach. However, if the other effects of aspirin that aren’t related to cyclooxygenase — such as the inhibition of NF-kappa beta function — are important, then specific COX-2 inhibitors may not be as effective. Only time will tell how these specific inhibitors compare to the other medicines currently available.

Acetaminophen

Tylenol and Panadol both contain acetaminophen. Although they were once thought to work in part by inhibiting cyclooxygenase, the current data suggests this is probably not true. Exactly how acetaminophen works is still debatable, which is surprising based on the wide use of this medicine. What is known about acetaminophen is that its principal effects are on fever and pain sensation, but it does not stop inflammation. It also does not irritate the stomach or prevent clotting. It is therefore a suitable substitute for those who can’t take aspirin or other NSAIDs or for those who have ulcer, gout and hemophilia. There is increasing evidence indicating that high doses or long-term use of acetaminophen results in increased levels of its metabolites that can cause liver damage, especially if used with alcohol.

In summary

There are an increasing variety of medicines to take for pain, fever and inflammation. Picking which one is right for you can be difficult. So the next time you reach for one, remember that you have a variety of choices. Read the product labels carefully and if your choice doesn’t seem to be working for you or if you have a specific medical condition consult your doctor about which class of pain relievers may be best for you. Your doctor can assess the benefits and risks to help determine if changing your choice of medication is right for you.

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