Irrational Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Use: Clinical Impacts, Multiorgan Toxicological Hazards and Strategic Interventions in Pharmaceutical Care

Abstract

Background: Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) represent an indispensable pharmacological class globally for managing acute pain and chronic inflammatory disorders; however, extensive over-the-counter retail availability without mandatory prescription retention fosters pervasive self-medication and irrational use. Objectives: To systematically evaluate the clinical impacts of irrational NSAID consumption, delineate the molecular and hemodynamic mechanisms underlying multiorgan toxicity, analyze population consumption patterns and articulate the clinical gatekeeping role of pharmaceutical care in optimizing patient safety. Methods: An integrative review conducted in accordance with Ganong’s framework and reported following PRISMA 2020 recommendations (OSF registration: osf.io/8x9km). Electronic searches were executed across MEDLINE/PubMed, SciELO, LILACS and the CAPES Periodicals Portal covering January 2011 to August 2026. Two independent reviewers performed screening and quality appraisal. Results: From 102 retrieved records, 28 duplicates were removed, 74 were screened and 26 full-text reports were appraised, yielding 9 core empirical studies for quantitative and qualitative synthesis. Self-medication rates ranged between 62.5% and 89.5% across community cohorts, physical fitness practitioners and pediatric caregivers (where an 87.0% misuse rate and 6.5% dual antipyresis were documented). Non-selective cyclooxygenase (COX-1/COX-2) inhibition and selective COX-2 blockade induce substantial multiorgan toxicities: upper gastrointestinal bleeding Relative Risk (RR) 1.75 to 4.22), acute hemodynamic renal impairment via afferent arteriolar vasoconstriction, fluid retention, hyperkalemia, atherothrombotic vascular events (RR 1.37 to 2.22 for acute myocardial infarction), drug-induced liver injury and pseudoallergic leukotriene shunts. Hazardous pharmacodynamic drug interactions (e.g., ‘triple whammy’ nephrotoxic combinations with ACE inhibitors and diuretics) substantially compound these hazards. Conclusion: Clinical pharmaceutical care-operationalized through structured dispensing screening, contraindication verification, rigorous enforcement of a strict 3-to-5-day ceiling on non-prescription therapy, patient education and active pharmacovigilance-functions as an essential clinical barrier against preventable drug-related morbidity.