Non-Steroidal Anti-Inflammatory Medicines (NSAIDs)

What do non-steroidal anti-inflammatory medications do?

Non-steroidal anti-inflammatory medications (NSAIDs) effectively reduce inflammation and relieve pain. Inflammation is the body's protective response to irritation or injury and is characterized by redness, warmth, swelling, and pain. NSAIDs are used to treat a variety of symptoms such as pain, inflammation, and stiffness caused by rheumatoid arthritis and tendonitis. NSAIDs are also used to treat a variety of other conditions, such as osteoarthritis, muscle aches, backaches, dental pain, pain caused by gout, bursitis, menstrual cramps. They may also be used to reduce fever or relieve minor aches caused by the common cold.

How do NSAIDs work?

NSAIDs work by blocking the production of certain body chemicals that cause inflammation. NSAIDs are effective in treating pain caused by slow, prolonged tissue damage, such as the pain associated with an arthritic joint. NSAIDs are also effective in treating general or localized pain, such as back pain, menstrual cramps, and headaches.

NSAIDs work like corticosteroids (also called steroids) without many of the side effects associated with steroids. Steroids are man-made drugs that closely resemble cortisone, a naturally-occurring hormone. Like cortisone, NSAIDs are effective in reducing pain and inflammation often associated with joint and muscle diseases and injuries.

Are NSAIDs available without a prescription?

Yes. Over-the-counter NSAIDs are available without a prescription. Over-the-counter NSAIDs are available in much lower doses than comparable prescription NSAIDs. Current over-the-counter NSAIDs include:

• Aspirin compounds (such as Anacin®, Ascriptin®, Bayer®, Bufferin® and Excedrin®)
• Ketoprofen (such as Orudis KT®)
• Ibuprofen (such as Motrin®, Advil®, Nuprin® and Medipren®)
• Naproxen sodium (such as Aleve®)

Over-the-counter NSAIDs are effective in treating mild osteoarthritis and some muscle injuries. Ibuprofen and naproxen are also used to treat fever. As with any medication, always follow the directions on the label and the instructions from your health care provider.

How long should I use an over-the-counter NSAID?

Never use an over-the-counter NSAID continuously for more than three days for fever and 10 days for pain without consulting your health care provider. Over-the-counter NSAIDs are effective pain-relievers, but they are intended for short-term use. When taking NSAIDs for long periods of time, you should be carefully monitored by your health care provider so he or she can detect the development of harmful side effects and modify your treatment if necessary.

How long do NSAIDs take to work?

Depending on the NSAID and the condition intended to treat some NSAIDs may work within a few hours while others may take a week or two before most benefits are achieved. Generally, for acute muscle injuries, we recommend NSAIDs that work quickly, but may need to be taken as often as every 4 to 6 hours because of their short action time.

For osteoarthritis and rheumatoid arthritis which require long-term treatment we generally recommend NSAIDs that need to be taken only once or twice a day. However, it generally takes longer for these drugs to have a therapeutic effect.

When are NSAIDs prescribed?

NSAIDs are often prescribed for rheumatologic diseases, including rheumatoid arthritis and moderate to severe osteoarthritis. NSAIDs are also prescribed for moderately painful musculoskeletal conditions (such as back pain).

How are NSAIDs prescribed?

NSAIDs are prescribed in different doses, depending on the condition intended to treat. These drugs may need to be taken from once to up to four times a day. Do NOT increase dose without asking your prescriber first.

Your health care provider may prescribe higher doses of NSAIDs if you have rheumatoid arthritis, for example, because there is frequently a significant degree of heat, swelling, and redness and stiffness in the joints. Lower doses may be prescribed for osteoarthritis and acute muscle injuries, since there is generally less swelling and frequently no warmth or redness to the joints.

No single NSAID is guaranteed to work. Your health care provider may prescribe several types of NSAIDs in order to find the one that works best for you. Avoid aspirin and alcoholic beverages while taking NSAIDs.

What are some prescription NSAIDs?

How will my health care provider choose a NSAID that is right for me?

The effectiveness and the risks of drugs are considered when your health care provider plans your treatment. Your health care provider will work with you to develop an appropriate treatment program. The drugs that will be prescribed will match the seriousness of your condition. Your health care provider will consider the results of your medical history, physical exam, X-rays, and blood tests to create your treatment plan. Your health care provider will also consider the presence of other medical conditions.

It is important to meet with your health care provider regularly so he or she can detect the development of any harmful side effects and modify your treatment if necessary. Your health care provider may periodically order blood tests or other tests (including a kidney function test) to determine the effectiveness of your treatment and the presence of any harmful side effects.

What are some common side effects of NSAIDs?

Side effects may occur if you are taking large doses of NSAIDs or if you are taking them for a long period of time. Some side effects are mild and go away, while others are more serious and need medical attention.

Please note: The side effects listed below are the most common side effects. All possible side effects are not included. Always contact your health care provider if you have questions about your particular medication.

The most frequently reported side effects of NSAIDs are gastrointestinal symptoms, such as:

• Gas
• Feeling bloated
• Heartburn
• Stomach pain
• Nausea
• Vomiting
• Diarrhea and/or constipation

These side effects can generally be relieved by taking the drug with adequate amounts of food. NSAIDs may also be taken with milk or antacids (such as Maalox® or Mylanta®) to prevent gastrointestinal symptoms. If the symptoms continue, the NSAID may need to be stopped. You should contact your health care provider if the symptoms listed above do not stop after a few days of taking the NSAID with food, milk, or antacids.

Some other side effects of NSAIDs include:

• Dizziness
• Feeling lightheaded
• Problems with balance
• Difficulty concentrating
• Mild headaches

If these symptoms continue for more than a few days, stop taking the NSAID and contact your health care provider for more instructions.

What side effects should I tell my health care provider about right away?

If you experience any of the following side effects, it is important to call your health care provider right away.

• Fluid retention (recognized by swelling of the mouth, face, lips or tongue, around the ankles, feet, lower legs, hands and possibly around the eyes)
• Ringing in the ears
• Severe rash or hives or red, peeling skin
• Itching
• Unexplained bruising and bleeding
• Unusual weight gain
• Black stools – bloody or black, tarry stools
• Bloody or cloudy urine
• Severe stomach pain
• Blood or material that looks like coffee grounds in vomit (bleeding may occur without warning symptoms like pain)
• Blurred vision
• Wheezing, trouble breathing, or unusual cough
• Chest pain, rapid heartbeat, palpitations
• Acute fatigue, flu-like symptoms
• Jaundice
• Photosensitivity

Can I take NSAIDs if I'm being treated for high blood pressure?

Nonsteroidal anti-inflammatory agents can raise blood pressure in some people. Some people with known high blood pressure (hypertension) may have to stop taking NSAIDs, if they notice their blood pressure increases in spite of taking their blood pressure medications and following their diet. If you are taking antihypertension medication consult your health care provider before taking NSAIDs.

Is there anyone who should not take NSAIDs?

People who have the following conditions or circumstances should not use any type of NSAID until they are first evaluated by their health care provider:

• Children and teenagers with viral infections with or without fever should not receive aspirin or aspirin-containing products due to the risk of Reye’s syndrome
• Those who have an upcoming surgical procedure, including dental surgery
• Diabetes that is difficult to control
• Known kidney disease
• Known liver disease
• Known allergies to medications, especially aspirin
• Active peptic ulcer disease (stomach ulcers or previous history of stomach ulcer bleeding)
• Bleeding problems (people who have a history of prolonged bleeding time or who bruise easily)
• People who consume three or more alcoholic beverages per day
• High blood pressure that is difficult to control
• Active congestive heart failure
• Asthma that worsens when taking aspirin
• Pregnancy in the third trimester
• Simultaneous use with certain medications such as warfarin (Coumadin®), phenytoin (Dilantin®), cyclosporine (Neoral®, Sandimmune®), probenecid (Benemid®), lithium (Eskalith®, Lithobid®) and drugs used for arthritis, diabetes, high blood pressure, heart disease and vitamins

Can NSAIDs cause allergic reactions?

Very rarely, a nonsteroidal anti-inflammatory agent can cause a generalized allergic reaction known as anaphylactic shock. If this happens, it generally occurs soon after the person starts taking the NSAID. The symptoms of this reaction include:

• Swollen eyes, lips, or tongue
• Difficulty swallowing
• Shortness of breath
• Rapid heart rate
• Chest pain
• Decrease in sedation

If any of these symptoms occur, call 9-1-1 or have someone drive you to the nearest emergency room immediately.

Before medication is prescribed, tell your health care provider:

• If you are allergic to any medications, foods or other substances
• If you are currently taking any other medications (including over-the-counter medications) and/or herbal or dietary supplements.
• If you are pregnant, planning to become pregnant, or are breast-feeding.
• If you have problems taking any medications.
• If you have anemia, kidney or liver disease, stomach or peptic ulcers, heart disease, high blood pressure, bleeding or clotting problems, asthma, or growth in the nose (nasal polyps).

Before you start taking any new medication, ask your health care provider:

• What is the name of the medication?
• Why do I need to take it?
• How often should I take it?
• What time of day should I take it?
• Should I take it on an empty stomach or with meals?
• Where should I store the medication?
• What should I do if I forget to take a dose?
• How long should I expect to take the medication?
• How will I know it is working?
• What side effects should I expect?
• Will the medication interfere with driving, working, or other activities?
• Does the medication interact with any foods, alcohol, or other medications (including over-the-counter medications, herbal and/or dietary supplements)?

This information is a summary only. It does not contain all information about this medicine. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.This document was last reviewed on: 12/1/2008...#11086