NSAIDs
Nonsteroidal anti-inflammatory drugs reduce the inflammation that accompanies arthritis.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most-frequently used drugs to ease the pain, inflammation and stiffness that come with arthritis, bursitis and tendinitis. Most NSAIDs are inexpensive and often among the first medicines prescribed for people with achy joints. NSAIDs also are used to reduce fevers and relieve headaches. They are available to take by mouth or to rub on the skin over painful joints and muscles. (Aspirin is technically an NSAID, but this article does not discuss the use of aspirin.)
NSAIDs work by preventing an enzyme called cyclooxygenase (COX) from making hormone-like chemicals called prostaglandins. Prostaglandins are one of the body’s biggest contributors to inflammation.
Your body makes two different kinds of cyclooxygenase: COX-1 helps protect your stomach lining and COX-2 plays a role in inflammation. Most NSAIDs are nonspecific, meaning they interfere with both COX-1 and COX-2. While this helps relieve pain and inflammation, it also leaves your stomach vulnerable to ulcers and bleeding.
A specific type of NSAID, called a selective COX-2 inhibitor, blocks the COX-2 enzyme more than the COX-1 enzyme. The only selective COX-2 NSAID currently available in the United States is the prescription drug celecoxib (Celebrex).
Choosing an NSAID
The different NSAIDs work similarly, but some people respond better to one than another. If you’re just starting on NSAIDs, your doctor will likely have you try an over-the-counter (OTC) option. If you don’t get good relief, your doctor can switch you to another one.
Ibuprofen and naproxen are available in both OTC and prescription versions. OTC versions come in about half the strength of the prescription versions. At these lower doses, NSAIDs provide only pain relief. The anti-inflammatory benefits of NSAIDs are achieved at the higher doses found in prescription medicines.
The pain-relieving effects of NSAIDs begin quickly -- within a few hours. However, swelling and warmth in joints may take longer to get better; it can take up to two weeks before you see full benefits.
If you need short-term relief during a flare or while your other arthritis medicines take effect, your doctor may prescribe a short-acting NSAID that has to be taken several times per day. But if you’ll be taking the drugs for an extended time, your doctor may select one that needs to be taken only once or twice per day. If you are at high risk for GI problems, your doctor may choose celecoxib or recommend an additional medication that protects your stomach.
NSAIDs work by preventing an enzyme called cyclooxygenase (COX) from making hormone-like chemicals called prostaglandins. Prostaglandins are one of the body’s biggest contributors to inflammation.
Your body makes two different kinds of cyclooxygenase: COX-1 helps protect your stomach lining and COX-2 plays a role in inflammation. Most NSAIDs are nonspecific, meaning they interfere with both COX-1 and COX-2. While this helps relieve pain and inflammation, it also leaves your stomach vulnerable to ulcers and bleeding.
A specific type of NSAID, called a selective COX-2 inhibitor, blocks the COX-2 enzyme more than the COX-1 enzyme. The only selective COX-2 NSAID currently available in the United States is the prescription drug celecoxib (Celebrex).
Choosing an NSAID
The different NSAIDs work similarly, but some people respond better to one than another. If you’re just starting on NSAIDs, your doctor will likely have you try an over-the-counter (OTC) option. If you don’t get good relief, your doctor can switch you to another one.
Ibuprofen and naproxen are available in both OTC and prescription versions. OTC versions come in about half the strength of the prescription versions. At these lower doses, NSAIDs provide only pain relief. The anti-inflammatory benefits of NSAIDs are achieved at the higher doses found in prescription medicines.
The pain-relieving effects of NSAIDs begin quickly -- within a few hours. However, swelling and warmth in joints may take longer to get better; it can take up to two weeks before you see full benefits.
If you need short-term relief during a flare or while your other arthritis medicines take effect, your doctor may prescribe a short-acting NSAID that has to be taken several times per day. But if you’ll be taking the drugs for an extended time, your doctor may select one that needs to be taken only once or twice per day. If you are at high risk for GI problems, your doctor may choose celecoxib or recommend an additional medication that protects your stomach.
As with all medicines, there are risks and benefits to consider when taking an NSAID.
Benefits
Pain Relief
At doses available in over-the-counter (OTC) products -- like ibuprofen, and naproxen – NSAIDs provide good, short-term pain relief. They can be used for headache, earache, toothache, joint pain, muscle pain, menstrual cramps, strains, and sprains.
Reduce Fever
NSAIDs, used at OTC doses, are antipyretic – meaning they reduce fever.
Fight Inflammation
At the higher doses available in prescription NSAIDs, the drug can battle inflammation caused by injury or arthritis. You will not get the full anti-inflammatory effect until you’ve been on the medicine for a week or two.
Risks
Gastrointestinal (GI) Problems:
When taking NSAIDs, you are more vulnerable to stomach pain, heartburn, nausea, diarrhea, ulcers and bleeding. The risk of GI problems is greater for people who take NSAIDs frequently or at high doses, those who are older than 65, have a history of stomach ulcers, or take blood thinners or corticosteroids.
Heart Attack and Stroke
Every NSAID (except aspirin) increases your risk of heart attack, stroke and heart failure. Your risk increases with higher doses and the longer you use the medication. However, the FDA warns that these serious side effects can occur as early as the first few weeks of using an NSAID. People with existing cardiovascular disease are at highest risk.
Having an inflammatory type of arthritis (like rheumatoid or psoriatic arthritis) or diabetes or being obese already increases your odds of developing heart problems, so adding the risks of long-term NSAID use must be considered carefully.
Having an inflammatory type of arthritis (like rheumatoid or psoriatic arthritis) or diabetes or being obese already increases your odds of developing heart problems, so adding the risks of long-term NSAID use must be considered carefully.
Allergic Reaction
NSAIDs can cause severe allergic reactions, especially in people with asthma, sinus problems or small growths in the nose (called nasal polyps). Allergic reactions can range from mild rashes to facial swelling and wheezing to anaphylactic shock. Just because you have taken one NSAID without reaction, doesn’t necessarily mean that all of them are safe for you. Each new drug you take carries a risk of allergic reaction.
Kidney Problems and Fluid Retention:
NSAIDs can decrease your kidney function. These are some of the symptoms that indicate your kidneys may not be working properly: your urine is cloudy, the amount of urine you pass suddenly decreases or you develop ankle swelling (which signals that you are retaining fluids). These problems may go away once you stop taking NSAIDs. Rarely, high-dose, long-term use of NSAIDs can cause chronic kidney disease known as chronic interstitial nephritis.
Bruising
Because NSAIDs prevent blood from clotting, you may bruise more easily and cuts may bleed for longer than you’re used to. Always check with your doctor if bruising is a problem for you.
Interaction with Other Medicines
NSAIDs can increase or decrease the actions of other medicines you take including high blood pressure medicines, blood thinners and antidepressants. They can also interact with alcohol. Additionally, because NSAIDs can be found in many OTC products (including allergy, sleep, cough and cold medicines) it is easy to accidentally take more than what is recommended. Always check for interactions with your doctor or pharmacist before adding any drug or dietary supplement to your existing treatment plan.
Side Effects and Solutions
Side Effects and Solutions
Most medications have side effects and NSAIDs are no exception. Side effects are more likely to happen if you take high doses of NSAIDs or if you have taken them for a long time. Some side effects are mild and go away on their own, but others are more serious and need medical attention.
Here are some common unwanted effects of NSAIDs, and ways you can help ease them.
Here are some common unwanted effects of NSAIDs, and ways you can help ease them.
Gastrointestinal (GI) Problems
NSAIDs can cause nausea, heartburn, vomiting, gas, belly pain, diarrhea or constipation. More serious stomach problems include ulcers and bleeding in the GI tract. Call your doctor right away if you have severe abdominal pain; a black, tarry bowel movement; or see any blood in your stool.
Solutions:
Stomach discomfort caused by NSAID use can usually be avoided by taking each dose after a full meal or with an antacid or other drug that protects the stomach.
Another option if you develop GI problems is to switch to the COX-2 selective inhibitor celecoxib (Celebrex). This drug has a lower risk of causing stomach problems than other NSAIDs.
Limit alcohol use when taking NSAIDs. It increases your risk of internal bleeding.
Be careful of combining medicines. Taking NSAIDs with a corticosteroid or a blood thinner such as warfarin (Coumadin) can increase your risk of GI bleeding. You can also cause problems if you take your prescription NSAID and then unwittingly take another medicine, such as an OTC cold remedy, that also contains an NSAID – so carefully read the label of any OTC medication you take occasionally.
Solutions:
Stomach discomfort caused by NSAID use can usually be avoided by taking each dose after a full meal or with an antacid or other drug that protects the stomach.
Another option if you develop GI problems is to switch to the COX-2 selective inhibitor celecoxib (Celebrex). This drug has a lower risk of causing stomach problems than other NSAIDs.
Limit alcohol use when taking NSAIDs. It increases your risk of internal bleeding.
Be careful of combining medicines. Taking NSAIDs with a corticosteroid or a blood thinner such as warfarin (Coumadin) can increase your risk of GI bleeding. You can also cause problems if you take your prescription NSAID and then unwittingly take another medicine, such as an OTC cold remedy, that also contains an NSAID – so carefully read the label of any OTC medication you take occasionally.
Cardiovascular Problems
All NSAIDs (other than aspirin) increase your chances of developing high blood pressure or having a heart attack or a stroke. People who already have cardiovascular disease are at the greatest risk.
Solutions:
The best thing you can do to prevent heart problems due to NSAID use is to reduce your other risk factors. Smoking, high blood pressure, high cholesterol and diabetes are significant risk factors for heart disease. Commit yourself to controlling, reducing or eliminating those other risk factors.
If you take medicine for high blood pressure, have your pressure checked regularly while taking NSAIDs.
If you take low-dose aspirin to prevent heart attack and stroke, some NSAIDs, including ibuprofen and naproxen, can interfere with that protective effect. So be sure to discuss NSAID choice with your doctor.
Take the lowest effective dose of NSAID for the shortest amount of time possible. And make sure you aren’t getting NSAIDs from multiple sources.
Solutions:
The best thing you can do to prevent heart problems due to NSAID use is to reduce your other risk factors. Smoking, high blood pressure, high cholesterol and diabetes are significant risk factors for heart disease. Commit yourself to controlling, reducing or eliminating those other risk factors.
If you take medicine for high blood pressure, have your pressure checked regularly while taking NSAIDs.
If you take low-dose aspirin to prevent heart attack and stroke, some NSAIDs, including ibuprofen and naproxen, can interfere with that protective effect. So be sure to discuss NSAID choice with your doctor.
Take the lowest effective dose of NSAID for the shortest amount of time possible. And make sure you aren’t getting NSAIDs from multiple sources.
Allergic Reaction
You could be allergic to any medicine, including NSAIDs.
Solutions:
Be aware of allergic symptoms, like rash, hives, facial swelling, wheezing and difficulty breathing. If you have a mild reaction, antihistamines like diphenhydramine (Benadryl) will ease the symptoms until the medicine works its way out of your system.
If you have a serious reaction, like throat swelling or breathing difficulty, call 911 immediately.
Solutions:
Be aware of allergic symptoms, like rash, hives, facial swelling, wheezing and difficulty breathing. If you have a mild reaction, antihistamines like diphenhydramine (Benadryl) will ease the symptoms until the medicine works its way out of your system.
If you have a serious reaction, like throat swelling or breathing difficulty, call 911 immediately.
Kidney Problems
NSAIDs can affect your kidneys, decreasing their function.
Solutions:
If you know you have kidney disease, check with your doctor before you take any NSAID, including over-the-counter ones.
Simple blood and urine tests can be used to test your kidney function.
NSAID-related kidney problems are usually reversible once you stop taking these medicines.
Solutions:
If you know you have kidney disease, check with your doctor before you take any NSAID, including over-the-counter ones.
Simple blood and urine tests can be used to test your kidney function.
NSAID-related kidney problems are usually reversible once you stop taking these medicines.
Bruising and Bleeding
NSAIDs reduce your blood’s ability to clot, so you may bruise more easily and find that cuts are slower to stop bleeding.
Solutions:
Be certain to check with your doctor or pharmacist before starting an NSAID, or any new medication or supplement, to be sure that your medications don’t interact and cause bleeding. For example, bleeding can be a serious problem if you take NSAIDs on top of blood thinners like warfarin (Coumadin). Certain herbal supplements, including willow bark, are also known to thin the blood or prevent clotting, so you must be careful about taking them together with NSAIDs.
Because of their effects on blood clotting, your doctor will tell you to stop taking NSAIDs before any surgery.
Solutions:
Be certain to check with your doctor or pharmacist before starting an NSAID, or any new medication or supplement, to be sure that your medications don’t interact and cause bleeding. For example, bleeding can be a serious problem if you take NSAIDs on top of blood thinners like warfarin (Coumadin). Certain herbal supplements, including willow bark, are also known to thin the blood or prevent clotting, so you must be careful about taking them together with NSAIDs.
Because of their effects on blood clotting, your doctor will tell you to stop taking NSAIDs before any surgery.
Take the lowest dose possible for the shortest amount of time.
Take with food.
If you are considering long-term therapy, talk to your doctor about whether you might need a COX-2 inhibitor or an additional medication to protect your stomach.
Be aware of potential interactions with your other, regular medications and supplements, and any OTC drug you might take occasionally.
Do not use if you recently have had heart bypass surgery (CABG); talk to your doctor about using NSAIDs if you have existing heart disease.
Take with food.
If you are considering long-term therapy, talk to your doctor about whether you might need a COX-2 inhibitor or an additional medication to protect your stomach.
Be aware of potential interactions with your other, regular medications and supplements, and any OTC drug you might take occasionally.
Do not use if you recently have had heart bypass surgery (CABG); talk to your doctor about using NSAIDs if you have existing heart disease.
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