What do nonsteroidal anti-inflammatory drugs do?

Nonsteroidal anti-inflammatory drugs (NSAIDs) effectively reduce inflammation (swelling) and relieve pain. Inflammation is the body's way of protecting itself after irritation or an injury. Signs of inflammation include 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 several other conditions, such as:

  • Osteoarthritis
  • Muscle aches
  • Backaches
  • Dental pain
  • Pain caused by gout
  • Bursitis, and
  • 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 from 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 of steroids. Steroids are man-made drugs that are very similar to 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, in much lower doses than prescription NSAIDs. Current over-the-counter NSAIDs include:

  • Aspirin compounds (such as Anacin®, Ascriptin®, Bayer®, Bufferin® and Excedrin®)
  • Ibuprofen (such as Motrin® and Advil®)
  • 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 healthcare 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 talking to your healthcare 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 healthcare provider so he or she can watch for harmful side effects and change your treatment, if necessary.

How long do NSAIDs take to work?

Depending on the NSAID and the condition being treated, 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; however, these may need to be taken as often as every four to six hours because of their short action time.

For osteoarthritis and rheumatoid arthritis that need long-term treatment, we usually 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 (healing) 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 that is being treated. These drugs may need to be taken from one to four times a day. Do NOT increase the dose without asking your health care provider first.

Your healthcare provider may prescribe higher doses of NSAIDs if you have rheumatoid arthritis, for example, because this disease often causes 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 in the joints.

No single NSAID is guaranteed to work. Your healthcare 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?

Below is a list of some prescription NSAIDS. Please note: this is NOT an all-inclusive list. In addition, many NSAIDs are only available as generic formulations.

Generic name/brand name (if still available)
  • Celecoxib (Celebrex®)
  • Diclofenac (Voltaren® [available by brand name in topical form])
  • Diflunisal
  • Etodolac
  • Fenoprofen (Nalfon®)
  • Flurbiprofen
  • Ibuprofen
  • Indomethacin (Indocin® [available by brand name in liquid form])
  • Ketoprofen
  • Ketorolac tromethamine
  • Meclofenamate sodium
  • Mefenamic acid (Ponstel®)
  • Meloxicam (Mobic®)
  • Nabumetone
  • Naproxen sodium (Anaprox®, Naprosyn®)
  • Oxaprozin (Daypro®)
  • Piroxicam (Feldene®)
  • Sulindac
  • Tolmetin
  • Salicylate
  • Salsalate (Disalcid®)

How will my healthcare provider choose an NSAID that is right for me?

In planning your treatment, your healthcare provider will take into account the effectiveness and the risks of drugs. Your healthcare 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 healthcare provider will consider the results of your medical history, physical exam, X-rays, blood tests, and the presence of other medical conditions in creating your treatment plan.

It is important to meet with your healthcare provider regularly so he or she can watch for any harmful side effects and change your treatment, if necessary. Your healthcare provider may order blood tests or other tests (including a kidney function test) from time to time to determine how effective your treatment is, and to look for any harmful side effects.

Are there specific warnings associated with NSAID use?

The Food and Drug Administration added new warnings about NSAIDs in July 2015.

NSAIDs can increase the chance of heart attack or stroke. This risk may be greater if you have heart disease or risk factors (for example, smoking, high blood pressure, high cholesterol, diabetes) for heart disease. However, the risk may also be increased in people who do not have heart disease or those risk factors.

Heart problems caused by NSAIDs can happen within the first weeks of use, and may happen more frequently with higher doses or with long-term use.

NSAIDs should not be used right before or after heart bypass surgery.

NSAIDs may increase the chance of serious stomach and bowel side effects like ulcers and bleeding. This risk may be greater in older individuals. These side effects can occur without warning signs.

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 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. All possible side effects are not included. Always contact your healthcare 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 healthcare 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 healthcare provider for more instructions.

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

If you have any of the following side effects, it is important to call your healthcare 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 (greater sensitivity to light)
  • Change in strength on one side is greater than the other, trouble speaking or thinking, change in balance
  • Inability to pass urine, or change in how much urine is passed
  • Very bad back pain
  • Very bad headache
  • Feeling very tired and weak

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

NSAIDs can raise blood pressure in some people. Some people with high blood pressure (hypertension) may have to stop taking NSAIDs, if they notice that their blood pressure increases even if they are taking their blood pressure medications and following their diet. If you are taking blood pressure medication, talk to your healthcare 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 healthcare 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, other NSAIDs, and sulfa drugs
  • Nasal polyps (linked to a greater chance of NSAID allergy)
  • Active peptic ulcer disease (stomach ulcers or previous history of stomach ulcer bleeding)
  • Gastroesophageal reflux disease, also known as GERD
  • Crohn’s disease or ulcerative colitis
  • Bleeding problems (people who have a history of prolonged bleeding time or who bruise easily)
  • People who have three or more alcoholic beverages per day
  • High blood pressure that is difficult to control
  • Active congestive heart failure
  • Asthma that gets worse when taking aspirin
  • Pregnancy in the third trimester
  • History of stroke or heart attack
  • If you are 65 years of age or older
  • Simultaneous use with certain medications such as warfarin (Coumadin®), clopidogrel (Plavix), corticosteroids (for example, prednisone), phenytoin (Dilantin®), cyclosporine (Neoral®, Sandimmune®), probenecid, lithium (Lithobid®) and drugs used for various disease states such as arthritis, diabetes, high blood pressure, heart disease, and vitamins and other dietary/herbal supplements
  • Phenylketonuria (PKU). Some nonprescription NSAIDs are sweetened with aspartame, a source of phenylalanine.

Before you start taking over-the-counter NSAIDs, have your physician or pharmacist evaluate all of your current medications to see if there would be any potential interactions.

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 usually 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 healthcare 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 healthcare 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 these medicines. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other healthcare provider.

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