Non-Selective COX Inhibitors: Any COX Will Do!

I know, I’m getting a little carried away with the punny titles, and they aren’t even that good.  What can I say?

The Non-Selective NSAID’s are generally the ones you see every day:  ibuprofen (Advil, Motrin, Nuprin) and aspirinNaproxen sodium is another one of these, but for now let’s chalk it off as more like ibuprofen.
These two drugs (ibuprofen and aspirin) are very similar in site and mode of action, but because of their formulations, individual properties, and potencies, they have a slightly different effect on the body.  Since now you know what COX-1 and COX-2 are responsible for, I’ll just give you a quick run-down of the ups and downs of the non-selective NSAIDs.


Therapeutic effects (from COX-2 inhibition):  Anti-inflammatory, analgesic, mild anti-pyretic, vasoconstrictor

Adverse effects (from COX-1 inhibition):  Mucosal damage, nephrotoxicity, bleeding (especially in the GI tract).  COX-2 inhibition can also cause problems with vasoconstriction, like a rise in blood pressure!


Therapeutic effects (from COX-1 AND COX-2 inhibition)Anti-inflammatory (C-2), analgesic (C-2), mild anti-pyretic (C-2), vasoconstrictor (C-2), Anti-platelet (C-1).  You may have noticed that in this case, the anti-platelet effects of aspirin can be considered therapeutic.  It has a stronger blood-thinning capacity at normal dose than ibuprophen, which makes it important in stroke/clot/MI prophylaxis!

Adverse effects (from COX-1 inhibition):  Bleeding, bleeding, bleeding.  Especially from the GI tract.  Aspirin is WAY better at stopping thrombus formation than ibuprofen, so it’s a really bad idea to give it to anyone with a tender stomach or bleeding problem.  Just like ibuprophen, it can cause damage to the mucosa and renal system, too!

When we are giving medications, we always have to be aware of existing and potential problems.  As you can see, NSAIDs, especially aspirin, have the potential of causing some serious complications.  On top of all of this, they are OVER THE COUNTER!   Many, many people pop aspirin because it is “good for you” and “no big deal”.  Same thing with ibuprofen.

Next time you have a killer hangover, by the way, do yourself a favor and eat something before you assault your mucosa.


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