NSAIDs: Do We Need to Worry About Side Effects?

Do we need to worry about NSAID side effects?
Although side effects are uncommon, they can be life- threatening. This is particularly problematic for a drug class that equine veterinarians frequently administer to horses because the tendency is to not think carefully about side effects.

What are the most important actions of NSAIDs?
Nonsteroidal anti-inflammatory drugs (NSAIDs) are used extensively for treatment of inflammation and pain in horses, particularly those with gastrointestinal or musculoskeletal disease. The mechanism of action of the NSAIDs used in equine practice is inhibition of cyclo-oxygenase (COX) activity, thereby inhibiting prostaglandin production. However, the recent discovery of multiple isoforms of COX has revolutionised the field of NSAID pharmaceutical development, leading to a number of drugs that are preferential for one of the COX isoforms. Of the 2 COX isoforms, COX-1 is constitutively expressed in most tissues, and has therefore been credited with synthesising prostanoids involved in physiological organ function, whereas COX-2 is typically upregulated by inflammatory stimuli such as endotoxin, and has therefore been the target of selective drugs aimed at inhibiting inflammation without disrupting normal organ function. The COX-2 inhibitors are now being extensively studied in the horse, and there is potential for improving anti- inflammatory treatment by lessening the onset of side effects. [...]