Which medications in the drug class Analgesics, Nonsteroidal anti-inflammatory drugs (NSAIDs) are used in the treatment of Nephrolithiasis?

Updated: Jun 21, 2018
  • Author: Chirag N Dave, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Analgesics, Nonsteroidal anti-inflammatory drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit pain and inflammatory reactions by decreasing activity of cyclooxygenase, which is responsible for prostaglandin synthesis. Both properties are beneficial in the management of renal (ureteral) colic.

These agents are at least if not more effective than narcotic analgesics in numerous randomized controlled trials. They have now become the recommended standard of care analgesia in acute renal colic, though must be used with caution in patients with renal insuffiency. NSAIDs cause less nausea and less sedation than narcotic analgesics, do not cause respiratory depression, and have no abuse potential. Potential adverse effects on renal function, gastrointestinal (GI) mucosa, and platelet aggregation do not appear clinically important when they are used for short-term pain relief.

Ketorolac

Ketorolac inhibits prostaglandin synthesis by decreasing the activity of COX, which results in decreased formation of prostaglandin precursors. Its onset of action is evident within 10 min.

Ketorolac intranasal (Sprix)

Intranasal ketorolac inhibits cyclooxygenase, an early component of the arachidonic acid cascade, resulting in reduced synthesis of prostaglandins, thromboxanes, and prostacyclin. It elicits anti-inflammatory, analgesic, and antipyretic effects. It is indicated for short-term (up to 5 d) management of moderate to moderately severe pain. Bioavailability of a 31.5-mg intranasal dose (2 sprays) is approximately 60% of a 30-mg intramuscular (IM) dose. The intranasal spray delivers 15.75 mg per 100-µL spray; each 1.7-g bottle contains 8 sprays.

Ibuprofen (Motrin, Advil, Addaprin, Caldolor, Dyspel, Genpril)

Ibuprofen is an oral NSAID. It has antipyretic, analgesic, and anti-inflammatory properties and is used for outpatient management.

Meloxicam (Mobic, Vivlodex)

Meloxicam decreases COX activity, and this, in turn, inhibits prostaglandin synthesis. These effects decrease the formation of inflammatory mediators.


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