COX-inhibiting nitric oxide donators (CINODs), also known as NO-NSAIDs, are a new class of nonsteroidal anti-inflammatory drug (NSAID) developed with the intention of providing greater safety than existing NSAIDs.[1][2][3][4]

These compounds were first described by John Wallace[5] and colleagues. CINODs are compounds generated by the fusion of an existing NSAID with a nitric oxide (NO)-donating moiety by chemical means, usually by ester linkage. CINODs retain the anti-inflammatory efficacy of NSAIDs via inhibition of cyclooxygenase (COX) while arguably improving upon gastric and vascular safety, most likely via vasorelaxation, inhibition of leukocyte adhesion and inhibition of caspases, all known effects of NO.

The first CINODs were developed in the 1990s, and as yet none have been approved for use by the general public. The importance of developing such drugs was increased when COX-2-specific NSAIDs rofecoxib (Vioxx) and lumiracoxib (Prexige) were removed from major pharmaceutical markets in the mid-2000s due to vascular safety concerns. In addition, traditional NSAIDs increase blood pressure and interfere with the actions of antihypertensive drugs. Several CINODs are currently being tested in clinical trials, the most advanced of which are being conducted by the French pharmaceutical company NicOx, whose flagship compound naproxcinod (NO-naproxen, nitronaproxen) is in phase III trials for the treatment of osteoarthritis.[6] Naproxcinod is a fusion of naproxen and a NO-donating group. Other CINODs are also being tested by NicOx for the treatment of diseases in which inflammation plays a role.[7]


  1. ^ Wallace JL, Reuter BK, Cicala C, McKnight W, Grisham MB, Cirino G (1994). "Novel nonsteroidal anti-inflammatory drug derivatives with markedly reduced ulcerogenic properties in the rat". Gastroenterology. 107 (1): 172–179. doi:10.1016/0016-5085(94)90074-4. PMID 8020659.
  2. ^ Wallace JL, Cirino G (1994). "The development of gastrointestinal-sparing anti-inflammatory drugs". Trends Pharmacol Sci. 15 (11): 405–406. doi:10.1016/0165-6147(94)90083-3. PMID 7855901.
  3. ^ Keeble JE, Moore PK (2002). "Pharmacology and potential therapeutic applications of nitric oxide-releasing non-steroidal anti-inflammatory and related nitric oxide-donating drugs". Br J Pharmacol. 137 (3): 295–310. doi:10.1038/sj.bjp.0704876. PMC 1573498. PMID 12237248.
  4. ^ White, WB (2007). "Cardiovascular effects of the cyclooxygenase inhibitors". Hypertension. 49 (3): 408–418. doi:10.1161/01.HYP.0000258106.74139.25. PMID 17261646. Archived from the original on 2008-03-04. Retrieved 2008-03-05.
  5. ^ John Wallace, Professor, Department of Pharmacology and Therapeutics, University of Calgary
  6. ^ HCT 3012 - COX-Inhibiting Nitric Oxide-Donator (CINOD) for Relief of Pain and Inflammation
  7. ^ "NicOx pipeline: product portfolio". Archived from the original on 2007-12-14. Retrieved 2007-12-27.