This presentation shows the types of drugs, their uses, trade names in Egypt and drug interactions with them Please pray for my brother Fahd for mercy and forgiveness and to admit him to heaven ,May God grant rest to his soul and keep it in Paradise.

1. Non-steroidal anti-
inflammatory drugs
Presented by
Mohamed Omar Ismail
A periodontist

2. Dedication
I dedicate this to the soul of my friend fahd ghanem

3. 1. Introduction
Pain: An unpleasant sensory & emotional experience associated with actual or potential
tissue damage
Analgesic :A drug that selectively relieves pain by acting in the CNS or on peripheral pain
mechanisms, without significantly altering consciousness
Classes of analgesic drugs
• Nonsteroidal anti-inflammatory drugs (NSAIDS)
• Enzyme derived analgesics derived from natural products (natureceuticals)
• Opioid analgesics

4. Non selective
COX
inhibitor
Preferential
Cox2
Inhibitor
Selective
Cox2
Inhibitor
Analgesic
antipyretic
with poor anti
inflammatory

5. Eicosanoids (prostaglandins, thromboxanes,leukotrienes, lipoxins)
Eicosanoids are involved in most types of Inflammation
PGI2 (prostacyclin) is located predominantly in vascular endothelium.
Main effects:•vasodilatation •inhibition of platelet aggregation
TxA2 is found in the platelets.
Main effects:•platelet aggregation •vasoconstriction
PGE2 causes:• inhibition of gastric acid secretion •contraction of pregnant uterus •contraction of GI
smooth muscles
PGF2α – main effects:•contraction of bronchi •contraction of miometrium

6. Mechanism of Action of NSAIDs
Inhibition of the enzyme cyclooxygenase (COX).
Cyclooxygenase is required to convert arachidonic acid into thromboxanes,
prostaglandins, and prostacyclins.
COX-1 gets constitutively expressed in the body, and it plays a role in maintaining
gastrointestinal mucosa lining, kidney function, and platelet aggregation.
COX-2 is not constitutively expressed in the body; and instead, it inducibly expresses
during an inflammatory response.
COX-3 (in brain)

8. • Analgesia.
• Antipyresis.
• Antiinflammatory.
• Antithrombotic.
• Gastric mucosal damage.
• Bleeding: inhibition of platelet function.
• Limitation of renal blood flow.
• Delay / Prolongation of labour.
• Premature ductus arteriosus closure.
• Asthma & anaphylactoid reactions in
susceptible individuals.

9. Non
selective
COX
Inhibitor
Drugs
Group
Aspirin
Salicylic acids
Naproxen, Ibuprofen, Ketoprofen,
Oxaprozin and Flurbiprofen
Propionic acids
Mefenamic acid
Anthranilic acid
Diclofenac and Aceclofenac
Aryl-acetic acid derivative
Piroxicam and Tenoxicam
Oxicam derivatives
Ketorolac, Indomethacin, Nabumetone
Pyrrolo-pyrrole derivative
Sulindac and Indomethacin
Indole derivatives
Phenylbutazone, Oxyphenbutazone
Pyrazolone derivative

10. • Acetyl salicylic acid. Which Rapidly converted in the body to salicylic acid which is responsible for
most of its action.
• Only drug amongst NSAIDs which irreversibly inhibit COX.
• Absorption: Stomach and Small
intestine.
• Poor water solubility.
• Solubility higher at high
pH(alkaline medium)
• 80% plasma protein bound.
• Enters brain, crosses placenta.
• Excretion: Urine.
• T ½ 15-20min.
• Analgesic, Antipyretic, Anti
inflammatory.
• Acute rheumatic fever.
• Rheumatoid arthritis.
• Osteoarthritis.
• Postmyocardial infarction and
post stroke patients.

11. PHARMACOLOGICAL ACTIONS OF SALICYLATES
• Analgesic: 600mg equivalent to 60mg codeine.
• Antipyretic: promotes heat loss, resets hypothalamic thermostat.
• Anti-inflammatory: 3-6gm/day; quenching of free radicals.
• Respiration is stimulated; dose dependant.
• Metabolic: inflammatory doses; may decrease blood sugar in diabetics. Increased utilization of
Glucose
• CVS: no direct effect in therapeutic doses. Larger doses increase cardiac output to meet increased
peripheral O2 demand caused by direct vasodilation
• GIT: irritate gastric mucosa. causes epigastric distress, nausea & vomiting,Promotes the local back
diffusion of the acid acute ulcers, erosive gastritis, microscopic haemorrhages
• Blood: irreversibly inhibits thromboxane synthesis. Interferes with Platelet aggregation (BT)

12. Side effects
• At analgesic dose (
0.3
-
1.5 gm/day )
causes nausea,vomiting,epigastric
pain,increased blood loss in stool.
• Idiosyncrasy and hypersensitivity:
Infrequent
• Salicylism at antiinflammatory doses.
• Reye’s syndrome.
• Acute salicylate poisoning: fatal
dose 15
-
30 g; serum >50mg/dl.
Precautions & Contraindication
 Reye’s syndrome.
 Should be stopped 1 week before elective
surgery(Brennen et al. presented evidence
suggesting low-dose aspirin should be
continued during dental surgical
procedures).
 In Chronic liver diseases.
 During pregnancy & avoided in breast
feeding.
 Avoided inG-6-PD deficient individuals.
 Avoided in diabetics.

13. ASPICO 81 mg chewable tab
ACPOPHAR 81 mg tab
AGGREX 75mg tab
JUSPRIN 81 mg enteric coated tab
ASPOCID 75mg tab
ASPIRIN 75mg chew. tab
RIVO 75mg chewable tab
EZACARD 75mg enteric coated tab
ASPROTECT 100mg enteric coated tab
ASPIRIN PROTECT 100 mg gastro-resis
RIVO 100mg enteric coated. Tab
CARDIPRIN 100mg enteric coated tab
ASPO NASR 300mg tab
ASPAIN 300mg tab
ASPOCID 300 mg tab
RIVO MICRO 320mg tab
ECOPRIN 325mg enteric coated tab.
ASPIRIN 500mg tab.

14. Better tolerated than aspirin.
Anti- inflammatory,analgesic & antipyretic efficacy is lower than high dose of aspirin.
Dose: 400-800mg TD, Ibuprofen, Naproxen
• Naproxen
• more potent, but inhibits platelet aggregation & prolong BT. Has alonger
half‐life (13 hrs).
• 250mg BD-TD
• Adverse effects are similar: nephrotoxicity, jaundice, nausea, dyspepsia,
edema, rash, pruritus, tinnitus.
• Interactions and contraindications: same as aspirin.

15. Pharmacokinetics
• Orally.
• 90
% plasma protein
bound.
• Enter brain, synovial fluid,
placenta.
• Liver –hydroxylation ,
edinoroculg
noitagujnoc
.
• Excreted in urine.
Adverse effects
Gastric discomfort, nausea
& vomiting. Rashes.
Precipitate asthma.
Contraindication
• Not prescribed in
pregnant women &
should be avoided in
peptic ulcer patients.

16. Naprofen 500mg tab.
Naprofen 250mg tab.
Naprosyn 500 mg tab
Naprosyn 250 mg tab
Supusan 500mg supp.
Orgoproxen 500 mg tab
Naleve 375 mg enteric coated tab
Myoprox 250mg f.C.Tab .
Naproxen TRADE
NAME
Ibuprofen
In doses of 2.4 g daily it is equivalent to 4 g of Aspirin in anti-inflammatory effect.
Oral ibuprofen is often prescribed in lower doses (< 2.4 g/d), at which
it has analgesic but not antiinflammatory efficacy.
A liquid gel preparation of ibuprofen provides prompt relief in postsurgical dental pain.
In comparison with indometacin, ibuprofen decreases urine output less and also causes less fluid
retention.

17. Brufen 400mg tab
Brufen 200mg tab
Alphafen 800mg tab.
Alphafen 600mg tab
Brufen 600mg tab
Brufen retard 800mg sustaine
Dajuanofen 200 mg cap
Dajuanofen 400 mg f.C. Tab
FLAMOTAL 400MG F.C. TAB
Flabu 600 mg f.C. Tab
Flabu 400mg f.C.Tab
Dajuanofen 600 mg f.C. Tab
Flamotal 600mg f.C.Tab
Flamotal 800mg tab
Ibufen 200mg soft gelatin cap.
Ibufen 200mg tab
Mafo 200 mg f.C.Tab
Ibuprofen 400 mg tab
Ibuhexal 800mg prolonged re
Ibufen 400mg tab
Mafo 400 mg f.C.Tab
Marcofen 400 mg coated tab
Marcofen 400 mg sr cap
Maxiprofen 600mg tab
Peopobruf 500 mg tab
Nova-profen 400mg f.C. Tab
Nova-profen 200mg tab
Maxiprofen retard 800mg s.R
Profinal 200mg tab
Profinal 400mg tab
Profinal 600mg tab
Profusol 200 mg s.G. Cap
Alphafen 100mg/5ml susp.
Sinufen 800mg sr f.C. Tab
Rapifen 200mg soft gelatin cap
Profusol 400mg s.G cap
BRUFEMOL-N SUSP.
Brufen 100mg/5ml susp
Cetafen-n 120ml susp
Contafever n 200mg/5ml susp
IBUFLAM N SUSP.
IBUFEN 2% SUSP.
Ibucalmin 100mg/5ml syrup
Flabu 40mg/ml oral drops.
Ibuprofen 100mg/5ml susp.
Juspoled 100mg/5ml susp.
Mafo 100mg/5ml syrup
Marcofen 100mg/5ml susp.
Profinal paedi 20mg/ml susp
Peopobruf 50mg/1.25ml oral drop
Nova-profen 100mg/5ml susp.
Megafen-n 100mg/5ml susp.
Ultrafen 100 mg/5ml susp
Fast-bruf supp
Flamotal 300mg supp
Flamotal 500mg supp
Brufen 600 mg 20 eff. Gr. Sachet
Marcofen 500mg supp
Mepabrufen 500mg supp.
Marcofen 300mg paed. Supp
Mepabrufen 300mg supp
Marcofen 100mg infantile supp

18. Ketoprofen
The effectiveness of ketoprofen at dosages of 100–300 mg/d is equivalent to that of other NSAIDs
Bi-alcofan 150mg tab
Baskinta 100 mg cap
Alcofan 50mg cap
Alcofan 25mg tab
Bi-ketogesic 150mg tab
Bi-profenid 150mg scored tab
Doloket 50mg f.C. Tab
Flamibru 75mg cap
Ketalgipan 50mg f.C. Tab.
Gesiket 75 mg cap
Flamoguard xr 150mg er tab
Flamidose 75mg cap
Ketofan 100mg SR cap
Ketofan 200mg S.R. Cap
Ketofan 25mg tab
Ketofan 25mg tab
Ketogesic SR 200mg cap
Ketogesic 50mg cap
Ketofan 75mg cap
Ketofan 50mg cap
Ketolgin 25mg enteric coated
Ketolgin 50mg film coated tab
Ketolgin sr 200mg cap
Ketoprek 75 mg cap
Kit1 S.R. 200mg cap
Kit1 75 mg cap
Ketorest 150mg S.R. F.C. Tab.
Ketoprof 200mg E.R. Cap
Kupan 200mg S.R. Cap
Kupan 25mg tab
Kupan 50mg cap
Mepacofen 100mg S.R. Cap
Ketofan 12.5mg/5ml susp
Top fam 25mg tab
Profenid 50mg cap
Mepacofen 25mg tab.
Ketoprek 1mg/ml syrup
Profenid 1mg/ml syrup
Alcofan 100mg supp.
Ketogesic 100mg supp.
Ketofan100mg supp
Ketolgin 100mg supp.
Kupan 100mg supp.
Profenid 100mg supp.
ketoprof 100mg/2ml lm amp
Ketofan 100mg/2ml i.M. Amp
Ketolgin 100mg amp
Emiprofen 100mg/2ml amp
Doloket 100mg/2ml i.M. Amp.

19. Flurbiprofen
it has been shown in rat tissue to affect TNF-α and NO synthesis.
Hepatic metabolism is extensive. It does demonstrate enterohepatic circulation.
Fenoprofen
FENOPROFEN
TRADE NAME
Fenoprofen 300mg cap.
FLURBIPROFEN
Fenoprofen 600mg cap.
Froben 100mg tab.
Nalfosab 200mg cap.
Froben 50mg tab.
Nalfosab 300mg 10 cap.
Froben sr 200 mg cap
Oxaprozin
Oxaprin 600 mg tab.
Oxaprozinan 600 mg f.c. tab.
Oxaprozin

20. Dosage
Plasma t1/2
Drug
400-800 mg TDS
2 hr
Ibuprofen
250 mg BD-TDS
12-16 hr
Naproxen
100 mg BD-TDS
2-3 hr
Ketoprofen
300-600 mg TDS
2-4 hr
Fenoprofen
50 mg BD-Q1D
4-6 hr
Flurbtprofen
Dosage of Propionic acid derivatives

21. MEPHENAMIC ACID
- An Analgesic, Antipyretic & Anti-inflammatory drug,
- Exerts Peripheral as well as Central Analgesic Action
Adverse effects :
- Diarrhoea
- Epigastric distress is complained, but gut bleeding is not significant
DOSE: 250-500 mg TDS
Pharmacokinetics
- Oral absorption is slow but almost complete
- Partly metabolized & excreted in urine & in bile
Mefentan 250mg cap.
Farostan forte 500mg tab.
Pono 250mg cap.
Mafepain 500mg f.C. Tab
Ponoforte 500mg cap.
. Mefenam 500mg cap
Ponstan forte 500mg f.C. Tab.
Mefronil 500 mg tab
Ponagic forte 500mg f.C. Tab.
Trade name

22. Enolic acid derivative
Oxicam, or meloxicam,
Oxicam derivatives Piroxicam and Tenoxicam
Piroxicam
• Multiple action NSAID, Long acting, good anti-inflammatory, good analgesic-antipyretic action
– Reversible, non-selective COX inhibition
Inhibit inflammation in diverse ways -> inhibit WBC Chemotaxis, decreases free radicals production, IgM
Rheumatoid factor
• ADRs: Contrast COX-1 blocking action - GI side effects 4 more than ibuprofen • Low doses are
better tolerated and less ulcerogenic than indomethacin • Ulcer, bleeding 4 frequent in higher doses •
Rashes, pruritus, edema,
• Kinetics: Rapid complete absorption, 99% plasma bound, long t1/2 – 2 days ,excreted in bile and
urine

23. Inflacam 20 mg supp.
Feldoral 20mg supp.
Feldene 20mg supp.
Dispercam 20 mg supp.
Piroxifar 20mg supp.
Dispercam 20 mg/ml amp
Feldene 20mg/ml i.M. Amp
Feldoral 20mg/ml amp.
Brexin 20mg 10 tab.
Piroxifar 20mg/ml amp.
Inflacam 20 mg/ml amp
Inflacam 20 mg/ml amp
dispercam 10mg dispersible tab
dispercam 20mg dispersible tab
Feldene 10mg cap.
Feldene 10mg dispersible .Tab
Feldoral 20mg cap
feldene flash 20 mg 10 fast dis
sachet
Feldene 20mg cap
Feldene 20 mg dispersible tab.
Inflacam 10 mg cap.
inflacam 10 mg dispersible tab
inflacam 10 mg dispersible tab
Inflacam 20 mg cap.
vendocid 20mg cap
piroxifar 20mg dispersable tab
Piroxiden 20mg cap.
inflacam 20 mg dispersible tab
Piroxicam trade name

24. lornoxicam
• balanced blockade of COX 1 and 2
• good therapeutic efficacy
• profitable safety profile (lower occurrence of GIT adverse effects – compared to other NSAIDs)
Lorgeque 8mg f.C.Tab
Loranovil 8mg f.C. Tab
Lornox 4mg f.C. Tab
Lornicam 8mg rapid tab
Lornox 8 mg f.C. Tab
Lornox 8mg f.C. Tab
Lornoxicam 8mg f.C.Tab
Lornoxicam 4mg f.C.Tab
Noxilorn 8 mg f.C.Tab
Rheuxicam 4mg f.C.Tab.
Rheuxicam 8mg f.C.Tab.
Toprano 4mg f.C.Tab.
Xefo 4 mg f.C.Tab
Toprano 8mg f.C.Tab.
Xefo rapid 8 mg f.C.Tab
Xefo 8 mg f.C.Tab
Zeficam 4 mg f.C.Tab.
Zeficam 8 mg f.C. Tab
Xefo 8mg/2ml vial for i.M./I.V.
Lornoxicam 8mg/2ml vial for i.M
Zeficam 8mg/2ml vial for i.M./I.V.
Lornoxicam
trade name

25. Epicotil 20mg f.C.Tab.
Anoxicam 20mg tab.
Soral 20 mg cap.
Serelanocam 20mg f.C. Tab
Tenocam 20mg cap
Tenoxicam 20mg cap.
epic0t1l 20mg i.m./i.v. vial
Tenoxil 20mg tab.
soral 20mg vial i.m./i.v.
tenoxil 20mg i.v./1.m. lyophilized vial
Epicotil 20mg adult supp.
Anoxicam 20mg supp.
Tenocam 20mg supp.
Soral 20mg supp.
Tenoxicam trade name
Tenoxicam
Congener of piroxicam Similar properties and uses

26. • Phenylbutazone and Oxyphenbutazone [1949].
Potent antiinflammatory drug,but poor analgesic and antipyretic action.
Banned: risk of bone marrow depression.
• METAMIZOL
Potent and promptly acting analgesic and antipyretic but poor antiinflammatory .
Few cases of agranulocytosis reported. • Analgin, Novalgin, Baralgan, Ultragin etc
• PROPIPHENAZONE
Similar to metamizol.

27. Indication
Used in the past as a powerful painkiller and fever reducer.
Oblong pharmalgin 500mg tab.
Novalgin 500mgiml 3 amp. For i.M i.V. Inj.
Novalgin 500mg tab.
Analgin 500mg tab.
Novacid oblong 500 mg tab.
Novalgin oblong 500mg tab.
Analgex oblong 500mg. Tab.
Novalgin 50mg/ml syrup
Novalgin children 300mg supp.
Novacid 50mg/ml syrup
Pyrazolone derivatives trade name

28. • Indomethacin
• Potent anti-inflammatory drug, comparable to phenylbutazone.
• Analgesic action is better than phenylbutazone, it relieves only inflammatory or
tissue injury related pain.
• Highly potent inhibitor of PG synthesis and suppresses neutrophil motility.
• Pharmacokinetics
• Absorbed orally. Rectal absorption is slow but dependable. 90% bound to
plasma proteins. Partly metabolized in liver to inactive products
and excreted by kidney. Plasma t1/2 is 2-5 hours.

29. Adverse effects:
• High incidence of gastrointestinal & cardiovascular events
• Frontal headache, leukopenia, increased risk of bleeding
Contra indications:
• Pregnant women & children
DOSE: 25-50 mg BD /TDS (INDOCAP, IDICIN)
Indomethacin trade
name

30. Sulindac
A prodrug that converts into an active sulfide metabolite.
Antiinflammatory action < Indomethacin.
At lower doses, selectively inhibit extra renal prostaglandin synthesis.
Mechanism of Action :produces its analgesics and anti-inflammatory actions by inhibiting
Prostaglandin synthesis.
Pharmacokinets :Absorption: It is rapidly and completely absorbed after oral administration.
Distribution: It is distributed mainly in protein bound form. Metabolism: It undergoes
metabolism in the liver and produces active sulfide metabolite. Excretion: Drug and its
metabolites are excreted mainly in urine.
the recommended dosage is 200 mg twice a day
Rudac 150 mg tab.
Sulindac trade name
Rudac 200 mg tab.
Hi-dac 20omg tab.

31. pyrrole derivatives
(indomethacin, acemetacin and etodolac tolmetin and ketorolac)
ketorolac
• Potent analgesic – but modest anti-inflammatory – post operative pain –equal efficacy with Morphine (but
no receptor interaction)
• Inhibits PG synthesis – inhibits pain peripherally
short term management of moderate pain– rated superior to aspirin and paracetamol and equivalent to
ibuprofen– Concurrent use with morphine (reduce dose) – but not used withanticoagulant – not to be used
for more than 5 days
• Kinetics
Well absorbed orally and IM – highly plasma protein bound;t1/2 5– 7 Hrs – 60% excretes unchanged in urine
• ADRs: Nausea, abdominal pain, dyspepsia, ulceration, dizziness,nervousness, pain in injection site, rise in
serum transaminase, fluid retention etc.

32. Fam 10mg tab.
Adolor 10 mg f.C.Tab
Ketoral 10 mg tab.
Ketolac 10mg tab.
Adolor 15 mg amp
Adolor 30 mg amp.
Dolomine sterile 15mg/ml i.V./I.M.
fam 30mg/2ml amp
Ketolac 30mg/2ml amp. For i.M./I.V.
Ketorolin 30mg/2ml amp.
Ketorolac trade name

33. ACEMETACIN
blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain
Acemetacin trade name
Ost-map 60mg cap
Acemetacin stada 60mg cap
Etodolac tolmetin
It has also some COX2 selective action. So its anti-inflammatory action and the frequency of gastric
irritation is less as compared to other NSAIDs.
Etodine 300mg cap.
Etodine 200mg cap.
Etodolac 300mg tab.
Etodolac 600mg e r tab
magicdolac 300mg soft gelatin cap
Napilac 200mg cap
Punita 600mg f.C. Tab.
Punita 300mg f.C. Tab.
TRADE
NAME

34. Nimesulide
Its approved indications are the treatment of acute pain, the symptomatic treatment of osteoarthritis, and
primary dysmenorrhoea in adolescents and adults above 12 years old.
• Weak PG synthesis inhibitor, moderate COX-2 selective
– Other Mechanisms: reduced superoxide generation by neutrophils,inhibition of PAF, TNFα release & free radical
scavenging
– Completely absorbed and 99% plasma protein bound– Half life – 4-5 hours and excreted in urine
• ADRs: epigastric pain, nausea, loose motion, heart burn,rash, pruritus, somnolence and dizziness – GIT tolerant
but Ulceration - Fulminant hepatic failure
Preferential COX-2 inhibitors
Nimesulide, Diclofenac,
Aceclofenac, Meloxicam and
Nabumetone
nabumetone
• prodrug, hepatic activation

35. Diclofenac
• Analgesic-antipyrretic and antiinflammatory – efficacy similar to naproxen
• Inhibits PG synthesis – somewhat COX-2 selective– Reduced Neutrophil chemotaxis and reduced superoxide
generation– No antiplatelet action (COX-1 sparing) inhibits enzymes (elastases, collagenases
• 99% plasma protein bound – 2 hours half-life
• Good tissue and synovial fluid penetration
• ADRs: Mild epigastric pain, nausea, headache, dizziness and rashes – less gastric ulceration and bleeding
- Risk of heart attack and stroke
• Acceclofenac
• has significant analgesic and anti-inflammatory effect with good tolerance (low occurrence
of GIT adverse effects) - higher adherence to treatment of chronic diseases

36. Declofenac 50mg tab.
Declofenac 25mg tab.
Arthrofast 150 mg m.R. Tab
Anuva 50mg dispersible
tab.
Declophen 25mg tab.
Declophen 50 mg tab.
Declophen s.R. 100mg cap.
Diclac 150 id retard tab.
Diclosp s.R. 75mg.Cap.
Diclonatrium sr 75mg f.C.
Tab
Dicloferaz 50mg dispersible
tab
Diclac 75 id retard tab.
Divido 75mg dual release
cap
Divido 75mg dual release
cap
Epifenac 100mg s.R. Cap.
Epifenac 25mg enteric
coated tab
Flotac 75mg cap.
Fenaclomex 100mg s.R. Tab
Epifenac 75mg s.R. Tab
Epifenac 50mg enteric
coated
Goldfenac mr 75mg tab
Olfen 100mg s.R. Depocaps
!Olfen 25 mg lactabs
Olfen 50mg lactab
Rheumafen 75 mg sr cap.
Rheumafen 50mg enteric
coati
Rheumafen 25mg enteric
coati
Rheumafen 100mg s.R.Cap.
Rheumarene 25 mg e.C.
Tab.
Rheumarene 50mg tab.
Sigmafenac 75 mg s.R. Cap
Vantomor 50mg dispersible
tab
Voltaren sr 75mg f.C.Tab.
Voltaren sr 100mg f.C.Tab.
Voltaren 50mg tab.
Voltaren 25mg enteric
coated tab
Diclofenac
TRADE
NAME

37. Dolphin 75mg/3ml i.M
ampoule
Diclac 75 mg/3ml amp
Declophen 75mg/3ml
amp
Articavol 75mg/3ml amp.
Epifenac 75mg/3ml
i.M./I.V. amp
Olfen 75mg/2ml amp
Rheumafen 75mg/3ml
amp
Rheumarene 75mg/3ml
amp I.M
Baby relief 12.5mg supp,
Zacaglone 75mg/3ml amp.
Voltaren 75mg/3ml amp.
Romalex 75mg/3ml i.M.
Amp
Baby relief 25mg supp
Declophen 100mg supp.
Declophen 12.5mg
infantile supp
Declophen 25mg infantile
supp.
Epifenac 100mg rectal
supp.
Dolphin 50mg supp.
Dolphin 25 mg supp.
Dolphin 12.5mg supp.
Epifenac 12.5mg supp.
Epifenac 25mg supp.
Epifenac 50 mg supp.
Pharofen 100mg rectal
supp
Suppofen 100mg rectal
supp.
Romalex 25mg rectal
supp.
Romalex 100mg rectal
supp.
. Rheumarene 100 mg
supp.
Suppofen 25mg rectal
supp.
Suppofen 50mg rectal
supp.
Voltaren 100mg supp.
Flector 50 mg granules in
sachet
Diclofenac
TRADE
NAME

38. Fenac 100 mg tab.
Bristaflam 100 mg f.C.Tabs.
Amoflam 100mg enteric coated
ACCECLOFENAC
TRADE NAME
Lambroflam 100 mg f.C. Tab.
Aceclocopa 100 mg f.C. Tab.
Nabuxan 500mg coated tab.
Nabutone 750mg f.C.Tab
NABUMETONE
TRADE NAME
Rheumaton 500mg f.C.Tab.
Rheumaton 750mg f.C. Tab
Nabutone 500mg f.C. Tab.

39. Meloxicam
related to piroxicam that has been shown to preferentially inhibit COX-2 over COX-1, particularly at
its lowest therapeutic dose of 7.5 mg/d. It is not as selective as the other coxibs and may be
considered “preferentially" selective rather than“highly” selective.
It is associated with fewer clinical GIsymptoms and complications than piroxicam,diclofenac, and
naproxen. Other toxicities are similar to those of other NSAIDs.
Medexaflam 15mg tab.
Arthricox 15 mg tab.
Anti-cox ii 7.5mg cap.
Anti-cox ii 15mg tab.
Medexaflam 7.5mg tab
Melocam 15mg tab.
Melocam 7.5mg tab.
Meloflam 15mg f.C. Tab.
Mobic 15 mg tab
Mexicam 7.5mg f.C.Tab
Mexicam 15mg f.C.Tab.
Meloxicam 15mg tab
Mobic 7.5mg tab
Mobitil 15mg tab.
Mobitil 7.5mg tab
Moxen 15mg tab
Mexicam 15mg/3ml i.M.
Amp
Meloxicam 15mg/2ml amp
Melocam 15mg/2ml amp
Moxen 7.5mg tab
Mobic 15mg/1.5ml amp
Mobitil 15mg/1.5ml amp
Anti-cox ii 15mg/3ml amp
Anti-cox ii 15mg supp
Meloxicam 15mg supp
Meloflam 7.5mg supp
Melocam 15mg supp.
Medexaflam 15mg supp
Mexicam 15mg rectal supp
Mobic 15mg supp.
Mobitil 15 mg supp.
Meloxicam
Trade name

40. Selective COX-2 inhibitors
Celecoxib, Etoricoxib and
Parecoxib
Coxibs are selective COX-2 inhibitors. They exert antiinflammatory, analgesic, and antipyretic
action with low ulcerogenic potential. Coxibs can cause infertility. They have
prothrombotic cardiovascular risk. It does not affect platelet aggregation at usual
doses.
Etoricoxib
a second-generation COX-2-selective inhibitor with the highest selectivity ratio of any coxibs.
It is extensively metabolized by hepatic CYP450 enzymes followed by renal excretion and has an
elimination t1/2 of 22 h.
90 mg daily of etoricoxib has superior efficacy compared with 500 mg of naproxen twice daily in the
treatment of rheumatoid arthritis over 12 weeks.
has a GI safety profile similar to other coxibs.
Celecoxib

41. Celeborg 200 mg cap
Celeborg 100mg cap
Arythrex 200mg cap
Arythrex 100mg cap.
Celebrex 100mg cap
Celebrex 200mg cap
Celebrex 200mg cap
Celecox 200mg cap
Eurocox 100mg tab
Celoxib 200mg cap
Celoxib 100mg cap
Arcoxia 90 mg f.C.Tab
Arcoxia 60 mg f.C.Tab
Anselacox 90 mg
f.C. Tab
Anselacox 60 mg f.C. Tab
Recoxibright 120 mg
f.C.Tab
Recoxibright 30 mg f.C.Tab
Recoxibright 60
mg f.C.Tab
Recoxibright 90 mg f.C.Tab
Celecoxib
Trade name
Etoricoxib
Trade name

42. Analgesic-antipyretic with poor anti inflammatory action:
Paraaminophenol derivative: Paracetamol (acetaminophen)
Pyrazolone derivative:Metamizole and Propiphenazone
Benzoxazocine derivative:Nefopam

43. PARA-AMINO PHENOL DERIVATIVES (Paracetamol )
• CNS-raises pain threshold.
• negligible anti-inflammatory action.
• Poor inhibitor of PG synthesis in peripheral tissues, but more active on COX in brain.
• Gastric irritation is insignificant –except in overdose
• Does not affect function or clotting factors and is not
uricosuric.

44. • Orally.
• 1/3 is protein bound in plasma .
• Glucuronidation.
• Excreted rapidly in urine.
• Plasma t l/2 is 2-3 hours.
• Effects after an oral dose last 3-
5hrs.
Therapeutic Uses
• Headache.
• Musculoskeletal pain.
• Dysmenorrhoea.
• Safe in gastric irritation, ulceration, bleeding,
pregnancy & lactating mother.
Adverse effects
•Nausea, rashes, leukopenia.
•Acute PCT poisoning –Dose >150 mg/kg or >
10g in adult. Fatality >250mg/kg , jaundice
starts after 2 days.
(In chronic alcoholics,even 5
-
6 g/day taken
for a
few days can result in hepatotoxicity)
N-acetylcysteine (150mg/kg iv) is the drug of
choice.

45. Abimol 300mg rectal supp
Acetaminophen 125mg ped. Supp
Cetal 120mg infantile supp
Paracetamol trade name
Pyral 250mg children supp.
Paramol 125mg pediatric supp
Paralex 125 mg rectal pediatric
Paragesic 500 mg supp
Pyritrust 500 mg/50ml soln. I.V.
Raziphemol 1 gm/100ml soln
Rotapyretic 1 gm/100ml vial
Targecetal 1 gm/100ml vial
Cetal 250mg/5ml 60ml susp
Cetal 100mg/ml oral drops
Abimol 150mg/5ml syrup 125ml
Vedraphenal 1 gm/100ml soln
Cetamol 120mg/5ml pediatric
syrup
Febrimol oral drops
Fevano 200mg/5ml syrup
Paracetamol-120mg/5ml syrup
Tempra 160 mg/5ml syp.
Temporal 250mg/5ml susp
Pyral 100mg/ml oral drops
Paramol 120mg/5ml syrup
Thera-lo 3.2g/100ml oral susp.
Unicetamol 100mg/ml oral
drops
Abimol 500 mg tab
Adol 500mg cap
Panadol 500 mg tab
Novaldol (doliprane) 1 gm tab
Febrimol 500 mg tab.
Cetal 500mg tab
Panadol advance 500 mg tab
Panadol joint er tab
Paracetamol 500mg tab
Paragesic 500 mg tab
Paramol 500mg tab.
Stopadol 500 mg tab
Pyral 500mg tab
Grippo 200mg supp

46. Use of analgesic drugs in dentistry
1-Acute dental pain
Adverse effects
Dosing (Adults)
Analgesic drug
Gastric ulceration-
bleeding,diarrhea,
hepatotoxiciry,allergy, skin
rashes,urticaria,
cardiovascular-MI,
atherothrombosis,CHF,
ischemic stroke;Opioid side
effects-respiratory
depression, dependence,
etc.
200-400 mg every 6- 8 h
25-75 mg every 6- 8 h
50 mg. 3 times daily
50-100 mg tab every 8h
500 mg, followed by 250 mg every 6-8 h
500-1000 mg 3 times daily
200 mg 2 times daily
200-400 mg every 8 h
10 mg. 3 times daily (5 days max.)
Ibuprofen
Ketoprofen
Diclofenac
Flurbiprofen
Naproxen
Acetaminophen
Celecoxib
Etodolac
Ketorolac

47. 2-Children
1 0-1 5 mg/kg q4-6h
age 2-12 10 mg/kg q6-8h
over age of 12 200-400mg q4h
(1 mg/kg/tds or 1.5 mg/kg/bd, maximum
daily dose is 3 mg/kg).
(2 years or older: 5 mg/kg orally twice a day;
12 years or older: 220 mg orally every 8–12
h)
Acetaminophen
Ibuprofen
diclofenac
naproxen
Acetaminophen is the drug of choice.
Selective COX-2 inhibitors are the second option
3-For Elderly Patients:
Regular strength Acetaminophe(2-2.5 grams in divided doses/
day)
Codeine+Acetaminophen(30–60/325–650 mg every 4–6 h)
Oxycodone/Hydrocodone+Acetaminophen. 5/500 mg every 6 h
4-Liver & Kidney Disases:
Nimesulide is the drug of choice.
5-Asthamatic Patients:
Acetaminophen
6-pregnancy
.
Ibuprofen,Ketoprofen,Diclofenac,Flurbiprofen,Naproxen,Ketorolac,Etodolac
7-lactation

48. Analgesic clinical efficacy and safety in dental pain
management
Common reported adverse events of NSAIDs from COX-1 inhibitors, are dyspepsia, gastric ulceration-bleeding,
diarrhea
cardiovascular disease (congestive heart failure, atherothrombosis, myocardial infarction, ischemic stroke), reduced
renal perfusion, or nephrotic syndrome accompanied with edema, acute kidney failure in rare cases from COX-2
inhibitors.
Ibuprofen use in normal doses is one of the drugs with least risk or alternative option as selective COX-2 inhibitors.
Acetaminophen adverse effects resulting from their higher dosage, chronic use, or in patient with liver disease
Ibuprofen and naproxen are considered the safest NSAIDs. Overall risk from analgesic used in dentistry is low

49. it is recommended to suppress NSAID medication from 1–2 to 4–5 days, which also depends on the drug type
and dose regimen. NSAID usage for more than 10 days should be consulted with the practitioner.
Even though they are considered relatively safe within the recommended dosage for use of up to 10 days,
cautions should be exercised in NSAIDs-exacerbated respiratory disease, asthma, patients with prior
myocardial infarction who are receiving antithrombotic therapy and those with a history of renal disease
Due to safety concerns COX-2 selective inhibitors have been introduced as a safe alternative in dentistry
practice with superior analgesic and inflammatory conditions in periodontal diseases and after oral surgery
procedures. Etoricoxib and celecoxib groups were shown to be comparable to ibuprofen on its efficacy in the
dental pulpal pain or postoperative pain relief, third molar surgery but superior toacetaminophene

50. Naproxen is indicated in toothache and its pain relief efficacy is comparable with ibuprofen. It is comparable
with etodolac, but less effective in swelling when compared with diclofenac when they were used in oral
surgical procedures, including postoperative third molar surgery or orthodontic pain
Diclofenac is used in moderate to severe pain following third molar extraction and it could be used in an
intravenous form in risk population groups such as the elderly and renal insufficiency, postoperative
anticoagulation which uses ketorolac as the only choice for the moderate to severe acute pain. Very similar
effects were shown when transdermal diclofenac patches were used compared to oral administration .
.

51. Choices of NSAIDS
1. Mild to moderate pain — Paracetamol or low dose Ibuprofen
2. Post operative acute short lasting pain — Ketorolac, Propionic acid derivatives,
diclofenac or nimesulide
3. Acute musculo-skeletal, osteoarthritic or injury pain — Paracetamol or propionic
acid
4. Exacerbation of Rh. Arthritis, acute gout, ankylosing spondylosis — naproxen,
piroxicam, indomethacin
5. Gastric intolarance to NSAIDS - Selective COX-2 inhibitors

52. 6.H/o asthma — nimesulide or selective COX-2 inhibitors
7.Hypertension or risk of heart attack — COX-2 inhibitors and PA derivatives
8.Paediatric — paracetamol, elderly — low dose of NSAIDS
9.Pregnancy — Paracetamol
10.Fast acting ones — fever, headache and other short lasting pain SR preparations
for chronic long lasting pain
11.IHD, hypertension, DM — consider drug interactions

53. Preventton of AE
• Dose reduction
• Combination with protective drugs
• Antiulcerotics— proton pump inhibitors (lansoprazole, omeprazole)
• prostaglandine analogues (substitution)
• H2 antihistamines — (cimetidine, ranitidine, famotidine)
• antacids
• think about selective COX-2 inhibitors

54. Drug interactions with NSAIDs
Result
Drugs
Decrease diuresis
Diuretics
Decrease antihypertensive effect
Beta-blockers ,ACE inhibitors, , Ca-
channel
Increase of GI bleeding
Anticoagulants
Increase hypoglycemic risk
Sulfonylurea
Increase nephrotoxicity
Cyclosporine
Increase of GI bleeding
Alcohol
decrease NSAIDs effects
Antacids
increase the risk of bleeding including
also upper gastrointestinal and
postoperative bleeding
SSRIs (selective serotonin reuptake
inhibitors)

55. Contraindications Of NSAIDs