Pathogenetic Background of NSAIDS Adverse Effects and Peculiarities of the Different Age Groups Patients Application

The purpose of this review цфs to highlight the peculiarities of the using NSAIDs by children of different age groups, pregnant women, in different trimesters of pregnancy, elderly patients with cardiovascular disorders, kidney diseases to minimize and prevent serious side effects using of NSAIDs, taking into account the pharmacodynamic properties of the group, as well as the search for alternative ways to improve safety. NSAIDs a large group of drugs that are different in chemical structure, united by a common mechanism of pharmacological action by the cyclooxygenase blocking (COX) and reducing of prostaglandin's (PG) synthesis in the focus of inflammation or tissue damage. Pharmacodynamic features of the NSAID group are presented in terms of differences in the mechanism of action (inhibition of COX-1, COX-2). Adverse effects in the COX inhibitors appointment are largely due to an increase in leukotrienes synthesis. In this case takes place the synthesis of products of the predomination of the lipoxygenase pathway of arachidonic acid conversion. The study clarifies the most common side effects causes, such as gastrointestinal disorders, the occurrence of cardiovascular system complications, such as myocardial infarction, ischemic strokes and others. Particular attention should be paid to the appointment of NSAIDs to patients of different age groups, especially children and the elderly. The causes of negative side effects of NSAIDs in a group of children of the neonatal period, and the elder have been thoroughly disassembled. In fact, the most important factor in newborns is their rapid development of physiology. Some of these adverse reactions may be explained by the pharmacokinetics of development (for example, the competitive binding of albumin to bilirubin, the insufficient ability of alcohol dehydrogenase), while others relate to the pharmacodynamics of development (for example, oxygen toxicity on the retina and alveolar microvascular structures, neurons apoptosis after exposure of dexamethasone). The dosing regimen of these drugs are described from the viewpoint of safety for each age period. An in-depth analysis of NSAIDs using during of various trimesters of pregnancy, the most likely side effects, and the basic rules of treatment for this group of drugs are provided. The most frequent were violations that included reduction of limbs, changes in the structure of the amniotic wall, eye defects, oral cavity, pulmonary artery valve stenosis, and defects in the neural tube. However, scientists suggest being very careful when using NSAIDs by pregnant women in the first trimester of pregnancy notwithstanding the fact that there is an instruction on the frequency of using these drugs during pregnancy. If possible, pregnant women are advised to avoid or limit the use of these drugs in the early and late stages of pregnancy. In addition, the article presents data on the characteristics of NSAIDs in elderly patients, taking into account the concomitant diseases and the basic functioning indicators, which can affect on the pharmacokinetics and pharmacodynamics of medications, such as glomerular filtration rate and others. Taking into account the data received by scientists from all over the world, analyzing the results of randomized clinical trials, leading scientists developed the basic points for the prevention of complications associated with the intake of NSAIDs and published in 2015 as clinical recommendations "Rational application of NSAIDs in clinical practice", which should be considered by each doctor who prescribes the drugs of this group in their clinical practice. It is highlighted that the using NSAIDs by children and women during pregnancy should be carried out with a very careful weighting of all possible consequences, without exceeding the dosage regimens, and only those drugs that are allowed in one or another age group, or a trimester of pregnancy, and as short as possible.