Non-Steroidal

Anti-Inflammatory Drugs
(NSAIDs)
 OBJEKTIF :
1. Memberi definisi ‘Non-Steroidal Anti-
Inflammatory Drugs (NSAIDs)’.
2. Menyatakan tujuan/ indikasi ubat.
3. Menyatakan dos dan contoh ubat.
4. Menyatakan kaedah pemberian ubat.
5. Menyatakan tindakan ubat.
6. Menerangkan kesan sampingan dan
kontraindikasi ubat.
7. Memberikan nasihat spesifik dalam
pengambilan ubat.
 DEFINISI :
UBAT DARI BERBAGAI JENIS YANG
BERKONGSI FUNGSI DAN AKTIVITI
IAITU ANTIPIREKTIK, ANTI RADANG DAN
ANALGESIK
1. NSAIDs adalah sejenis ubat analgesik (non-
narcotik)
2. Tidak tergolong dalam kumpulan ubat steroid
3. Maka tidak menghasilkan kesan sampingan
berkaitan steroid
`TINDAKAN UBAT :
• NSAIDs BERTINDAK DENGAN MENGHALANG
PENGHASILAN PROTAGLANDIN
• PROSTAGLANDIN IALAH :
SEKUMPULAN ASID LEMAK YANG SECARA
SEMULAJADI BERADA DALAM TUBUH
MANUSIA YANG BERFUNGSI UNTUK :
1. MENGATUR REMBESAN ASID PADA PERUT
2. MENGATUR SUHU BADAN
3. MENGATUR AGREGASI PLATELET
4. KAWALAN KERADANGAN
Maka dengan pengurangan prostaglandin,
NSAIDs menghasilkan kesan:

• Anti-Inflammatory
• Analgesics
• Antipyretics
INDIKASI UMUM NSAIDs :
1. Relief of symptoms of :
• osteoarthritis
• rheumatoid arthritis
• musculoskeletel disoders
2. Mild to moderate pain relief
3. Primary dysmenorrhea
4. Fever reduction
 Contoh ubat

• Diclofenac sodium (Voltaren)

• Ibuprofen (Brufen)
• Indomethacin (Indocid)
• Ketoprofen (Orudis)
• Mefenamic Acid (Ponstan)
• Naproxen (Naprosyn)
• Piroxicam (Feldene)
1. Diclofenac sodium
(Voltaren)

Tindakan
• Antipyretics
• Analgesics
• Anti-inflammatory
 Indication

• Rheumatoid arthritis
• Osteoarthritis
• Spondylitis
• Acute gout
• Post operative inflammation
1(a). Diclofenac sodium
50mg tablet
(Voltaren)
Category: B
 Dose

• Rheumatoid & Osteoarthritis:

• 100-150mg/d PO (divided
doses)
• Spondylitis:
• 100-125mg/d PO (divided
doses)
 • Long term:
• 75-100mg/day PO (2-3 divided
doses)
• Max: 150mg/day
• Peads > 1yr:
• 1-3mg/kg/day (divided dose)

Note: Take this medicine after food

1(b). Diclofenac
sodium
75mg/3ml Inj

(Voltaren)
Category: A
 Dose
• 75mg once daily IM
• Severe cases: 75mg bd IM
• Max 2 days
1(c). Diclofenac sodium
1% Emulgel
(Voltaren)
Category: A

Dose
• Apply tds-qid & gently rub
 1(c). Diclofenac sodium
12.5mg/ 25mg/ 50mg suppositories
(Voltaren)
Category: A
 Dose
• Adult:
• 75-150mg/day (divided dose)
• Peads 1-12 yr:
• 12.5-25mg/day
2. Ibuprofen 200mg tablet
(Brufen)
Category: B

Tindakan
• Antipyretics
• Analgesics
• Anti-inflammatory
 Indication

• Mild to moderate pain

• Rheumatic & Arthritis
disorders
• Painful dysmenorrhea
 Dose
• Adult:
• 200-400mg tds
• Max: 2.4g/day
• Peads:
• 20-30mg/kg/day (divided
dose)

Note: Take this medicine after food

 3. Indomethacin
(Indocid)

Tindakan
• Antipyretics
• Analgesics
• Anti-inflammatory
 Indication
• Rheumatoid arthritis
• Spondylitis
• Mild to moderate
osteoarthritis
• Acute gouty arthritis
• Acute shoulder pain
3(a). Indomethacin
25mg capsule
(Indocid)

Category: B
 Dose
• Adult:
• 50-200mg/day (divided dose)
• Peads:
• Not recommended

Note: Take this medicine after food

3(b). Indomethacin
100mg suppository
(Indocid)

Category: B
 Dose
• Adult:
• 100mg ON
• Peads:
• Not recommended
 4. Ketoprofen
(Orudis)

Tindakan
• Analgesics
• Anti-inflammatory
 Indication

• Mild to moderate pain

• Rheumatoid disorders
• Painful dysmenorrhea
4(a). Ketoprofen
100mg/2ml Inj
(Orudis)
Category: A*
 Dose
• Adult:
• 50-100mg q 4 hr deep IM
• Max: 200mg/day for up to 3
days
• Peads:
• Not recommeded
 4(b). Ketoprofen
200mg Slow Release capsule
(Orudis)
Category: A
 Dose
• Adult:
• 100-200mg/day
• Peads:
• Not recommeded

Note: Take this medicine after food

4(c). Ketoprofen
2.5% gel (Orudis)

Category: A

Dose
• Apply twice daily
• Max: 20g/day
 4(d). Ketoprofen
30mg transdermal patch
(Orudis)
Category: A

Dose
• Apply 1 plaster to the
affected area bd
5. Mefenamic Acid
250mg capsule/ tablet
(Ponstan)
Category: B
 Dose
• Adult:
• 250-500mg tds PO (PRN)
• Limits to 7 consecutive
days

Note: Take this medicine after food

 • Peads > 6 months:
• 6.5-25mg/kg tds-qid PO
(PRN)
• Limits to 7 consecutive
days

Note: Take this medicine after food

6. Naproxen 250mg tablet
(Naprosyn)
Category: A

Tindakan
• Analgesics
• Anti-inflammatory
 Indication

• Mild to moderate pain

• Rheumatoid arthritis
• Osteoarthritis
• Spondylitis
• Acute gout
 Dose

• Arthritis & spondylitis:

• 500-1000mg/day (2 divided
dose)
• Acute gout:
• Initial: 750mg then 250mg q 8
hr (jika perlu)
• Musculoskeletal disorders &
dysmenorrhea:
• Initial: 500mg the 250mg q 6-8
hr (jika perlu)

Note: Take this medicine after food

7. Piroxicam 10mg capsule
(Feldene)
Category: A

Tindakan

• Analgesics
• Anti-inflammatory
 Indication
• Mild to moderate pain
• Rheumatoid arthritis
• Osteoarthritis
• Spondylitis
• Acute gout
• Primary dysmenorrhea
 Dose
• Arthritis & spondylitis:
• 20mg/day
• Maintenance: 10-30mg/day (single or divided
dose)
• Acute gout:
• 40mg/day (single or divided dose) for 4-6
days
• Musculoskeletal disorders:
• 40mg/day (single dose or
divided dose) for 2 days
• Then 20mg/day for 7-14
days

Note: Take this medicine after food

Kesan sampingan

• Gastrointestinal:
– Nausea
– Vomiting
– Diarrhea
– Epigastric distress
– Intestinal ulceration
– GI bleeding
• CNS: • CNS
– Dizziness
– Anxiety
– Insomnia
– Depression

• RENAL
• Renal:
– Hematuria
– Elevated blood urea
nitrogen
•• Cardiovascular:
CARDIOVASCULAR
– Congestive heart failure
– Decreased or increased BP
• •Hematologic:
HEMATOLOGIC
– Pancytopenia
– Leukopenia
– Thrombocytopenia
– Aplastic anemia
• Skin: • SKIN
– Rash
– Irritation
– Skin eruption
– Steven-Johnson syndrome

• Metabolic/ endocrinologic:
METABOLIC/ENDOCRINOLOGIC
– Decreased appetite
– Weight increase or decrease
– Menstrual disorders
• •Special
SPECIAL SENSES
senses:
– Visual disturbances
– Blurred vision
– Photophobia
– Tinnitus
– rhinitis
 Contraindication
• Allergic to NSAIDs
• Pregnancy
• Lactation
• Labor
• Renal & hepatic impairment
• Bleeding disorders
 Cautious
• Impaired hearing
• Cardiovascular disease
• GI condition
• Hypertension
• Elderly
 Interactions
• Anti-coagulants, lithium
– Risiko pendarahan
• Diuretics, anti-hypertensives
– Kesan diuretics &
antihypertensives berkurang
• Paracetamol (long-term)
– Renal impairment
 Nasihat
• Ubat diambil selepas sarapan
(kurangkan GI symptom)
• Periksa simptom pendarahan
salur GI (najis gelap)
• Elakkan pengambilan alkohol
• Monitor berat badan selalu
(kehadiran edema)
• Lapor kepada pegawai
perubatan & hentikan
pengambilan ubat jika berlaku
kesan sampingan seperti:
– Vertigo, ruam, hematuria,
gangguan pendengaran &
pengelihatan
THANK
YOU