Nonsteroidal anti-inflammatory drugs (NSAIDs) are medications commonly used to alleviate pain and reduce inflammation caused by anything from a simple tension headache to lower back pain or knee arthritis. But these drugs can have side effects and should be avoided by people with certain conditions. Learn how to safely use NSAIDs and reduce their side effects below.
Nonsteroidal anti-inflammatory drugs 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 asprin, ibuprofen and naproxen. Here is an extensive list of various NSAIDs:
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, but there are some serious considerations with these medications, as discussed below. 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 regarding gastrointestinal problems (such as ulcer development) and cardiovascular side effects.
If any of these guidelines are not clear, or if you think it does not apply to you, be sure to discuss the issue with your physician.
The most common side effects of NSAIDs are gastrointestinal problems, including stomach irritation and reflux. More rarely, NSAIDs can contribute to heart problems and increase the risk of cardiovascular conditions.
The black box warning for NSAIDs related to gastrointestinal risk reads as follows, in an example from the labeling for the NSAID naproxen (Naprosyn®):
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 NSAIDs related to cardiovascular risk reads as follows, in an example from the labeling for the NSAID naproxen (Naprosyn®):
Years ago, doctors thought of NSAIDs as being very safe. They still are acceptably safe for many people, but longer-term experience and medical studies have shown that there are definite risks. Think about these things before you start NSAIDs and consider them again if you are taking them for a while:
A good resource for the use of NSAIDs in pregnancy can be found at MotherToBaby's factsheet on naproxen. They point out that “It is unclear if naproxen use may affect the ability to become pregnant.” They note that “studies have suggested that the use of NSAIDs may increase the chance of miscarriage,” but suggest that this may be in the setting of long-term use of NSAIDs. Data to date overall do not suggest that NSAIDs cause any abnormalities of babies. NSAIDs are not recommended for use after week 20 of a pregnancy.
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 two 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.
Do not mix one NSAID with another. For example, don't take aspirin or ibuprofen with any other nonsteroidal anti-inflammatory drugs. However, your physician may wish you to combine low-dose aspirin with an NSAID for heart attack or stroke prevention. This is an individual decision for each patient, and you should discuss this with your physician, since combining an NSAID with aspirin can increase the risk of ulcer. Acetaminophen, especially in low dose, appears less likely to irritate the stomach than NSAIDs, so in many cases it is reasonable to take acetaminophen along with (or instead of) NSAIDs.
Always read the ingredients listed on the label of over-the-counter products. If acetylsalicylic acid or salicylate is listed, it may be better not to take this with NSAIDs, unless advised by your physician. Keep in mind that Alka-Seltzer, Anacin and some types of Excedrin contain aspirin.
If you are taking medications for high blood pressure, have your pressure checked regularly while on the nonsteroidal anti-inflammatory drug. This is especially important within the first several weeks of starting the drug. In some patients, NSAIDs can elevate the blood pressure.
You should cease taking NSAIDs if:
Talk to your doctor about switching away from NSAIDs if: