Non-steroidal anti-inflammatory drugs (NSAIDs) are a group of drugs that are prescribed to reduce the pain and inflammation of arthritis. Some of these drugs require a prescription, while others are available without one (over-the-counter or OTC). They include such drugs such as (generic names first, brand names in parentheses):
ibuprofen (Motrin, Advil, Rufen)
naproxen (Aleve, Naprosyn)
ketoprofen (Orudis, Oruvail)
salsalate (Disalcid, Trilisate)
NSAIDs do not include drugs that are purely pain relievers, such as acetaminophen (Tylenol) or codeine.
[A more recent group of NSAIDs known as COX-2 selective or COX-2 specific inhibitors are covered in a separate article on COX-2 inhibitors - presently limited to the agent celecoxib (Celebrex.)]
NSAIDs are generally tolerated very well by many patients, which is fortunate because these drugs are often very helpful for people with pain and inflammation. Most side effects are minor and easily reversible by discontinuing the drug or by adding a drug to counter such effects. The risk of serious side effects is small. Being aware of the possible side-effects of these drugs can make them even safer to use. Although most side-effects are minor, there is still a genuine concern re: gastrointestinal problems, such as ulcer development, and cardiovascular side-effects, as discussed.
If any of these guidelines are not clear, or if you think it does not apply to you, discuss the issue with your physician.
The “black box warning” for NSAIDs related to gastrointestinal risk reads as follows, in an example from the labeling for the NSAID naproxen (Naprosyn®):
"Gastrointestinal Risk: NSAIDs cause an increased risk of serious gastrointestinal adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These events can occur at any time during use and without warning symptoms. Elderly patients are at greater risk for serious gastrointestinal events."
The FDA has required a block box warning about cardiovascular thrombotic events be placed in the package description of all NSAIDs other than aspirin, including COX-2 specific and selective agent, and patients at high risk for cardiovascular disease need to weigh the risks and benefits with their physician before taking any NSAID or (COX-2 specific or selective agent). The “black box warning” for NSAID’s related to cardiovascular risk reads as follows, in an example from the labeling for the NSAID naproxen (Naprosyn®):
"Cardiovascular Risk: NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. This risk may increase with duration of use. Patients with cardiovascular disease or risk factors for cardiovascular disease may be at greater risk."
When you are trying an NSAID for the first time, take the full dose prescribed every day, unless instructed otherwise. It may take as long as 2 weeks to build up to a "blood level" of the drug, and the drug may not help very much until then. If you take the drug irregularly, you may never know whether it actually can help you. This could lead to your being switched to a second drug when the first one actually could have helped. Each new drug you take carries a risk of allergic reaction (such as skin rash). Therefore, it's important to find out if a drug can help you before switching to another.
Do not exceed the dose of the drug prescribed. The extra benefit is usually small and the increased risk is significant.
If you are taking the medicine regularly and miss a dose, take it as soon as possible. However, if it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Do not take a double dose. -- If your arthritis improves, discuss with your physician the possibility of decreasing your dose of the NSAID.
Combining NSAIDs with Other Drugs
When to Stop the Drug and Get Immediate Medical Attention
When to Call Your Doctor About Changing Dosage or Medications
Reviewed: 9/6/2009 Published: 12/23/2002