Table of
Contents
Definition
Nonsteroidal anti-inflammatory drugs are medicines
that relieve pain, swelling, stiffness, and
inflammation.
Purpose
Nonsteroidal anti-inflammatory drugs (NSAIDs) are
prescribed for a variety of painful conditions,
including arthritis, bursitis, tendinitis, gout,
menstrual cramps, sprains, strains, and other injuries.
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Description
Nonsteroidal anti-inflammatory drugs relieve pain,
stiffness, swelling, and inflammation, but they do not
cure the diseases or injuries responsible for these
problems. Two drugs in this category, ibuprofen and
naproxen, also reduce fever. Some nonsteroidal
anti-inflammatory drugs can be bought over the counter;
others are available only with a prescription from a
physician or dentist.
Among the drugs in this group are
- Aleve, Anaprox, Naprelan (naproxen
sodium)
- Ansaid (flurbiprofen)
- Daypro (oxaprozin)
- Lodine (etodolac)
- Mobic (meloxicam)
- Motrin, Advil
(ibuprofen)
- Naprosyn (naproxen)
- Relafen
(nabumetone)
- Toradol (ketorolac)
- Voltaren (diclofenac)
They are
sold as tablets, capsules, caplets, liquids, and rectal
suppositories and some are available in chewable,
extended-release, or delayed-release forms.
A newer group of NSAIDs known as COX-2 inhibitors are
being used successfully to treat patients with allergic
reactions to the older NSAIDs. Their name comes from the
fact that they block an enzyme known as
cyclooxygenase-2, or COX-2, which is involved in the
inflammation pathway. The COX-2 inhibitors are also less
likely to affect the patient's digestive tract. They
include such drugs as celecoxib (Celebrex).
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Recommended
Dosage
Recommended doses vary, depending on the patient, the
type of nonsteroidal anti-inflammatory drug prescribed,
the condition for which the drug is prescribed, and the
form in which it is used. Always take nonsteroidal
anti-inflammatory drugs exactly as directed. If using
non-prescription (over-the-counter) types, follow the
directions on the package label. For prescription types,
check with the physician who prescribed the medicine or
the pharmacist who filled the prescription. Never take
larger or more frequent doses, and do not take the drug
for longer than directed. Patients who take nonsteroidal
anti-inflammatory drugs for severe arthritis must take
them regularly over a long time. Several weeks may be
needed to feel the results, so it is important to keep
taking the medicine, even if it does not seem to be
working at first.
When taking nonsteroidal anti-inflammatory drugs in
tablet, capsule, or caplet form, always take them with a
full, 8-ounce glass of water or milk. Taking these drugs
with food or an antacid will help prevent stomach
irritation.
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Precautions
Nonsteroidal anti-inflammatory drugs can cause a
number of side effects, some of which may be very
serious (See Side effects). These side effects are more
likely when the drugs are taken in large doses or for a
long time or when two or more nonsteroidal
anti-inflammatory drugs are taken together. Health care
professionals can help patients weigh the risks of
benefits of taking these medicines for long periods.
Do not take acetaminophen, aspirin, or other
salicylates along with other nonsteroidal
anti-inflammatory drugs for more than a few days unless
directed to do so by a physician. Do not take ketorolac
(Toradol) while taking other nonsteroidal
anti-inflammatory drugs unless directed to do so by a
physician.
Because older people are more sensitive
than younger
adults to nonsteroidal anti-inflammatory drugs, they may
be more likely to have side effects. Some side effects,
such as stomach problems, may also be more serious in
older people.
Some nonsteroidal anti-inflammatory drugs can
increase the chance of bleeding after surgery (including
dental surgery), so anyone who is taking the drugs
should alert the physician or dentist before surgery.
Avoiding the medicine or switching to another type in
the days prior to surgery may be necessary.
Some people feel drowsy, dizzy, confused,
lightheaded, or less alert when using these drugs.
Blurred vision or other vision problems also are
possible side effects. For these reasons, anyone who
takes these drugs should not drive, use machines or do
anything else that might be dangerous until they have
found out how the drugs affect them.
Nonsteroidal anti-inflammatory drugs make some people
more sensitive to sunlight. Even brief exposure to
sunlight can cause severe sunburn, rashes, redness,
itching, blisters, or discoloration. Vision changes also
may occur. To reduce the chance of these problems, avoid
direct sunlight, especially from mid-morning to
mid-afternoon; wear protective clothing, a hat, and
sunglasses; and use a sunscreen with a skin protection
factor (SPF) rating of at least 15. Do not use sunlamps,
tanning booths or tanning beds while taking these drugs.
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Special
Conditions
People with certain medical conditions and people who
are taking some other medicines can have problems if
they take nonsteroidal anti-inflammatory drugs. Before
taking these drugs, be sure to let the physician know
about any of these conditions:
Let the physician know about any allergies to
foods, dyes, preservatives, or other substances.
Anyone who has had reactions to nonsteroidal
anti-inflammatory drugs in the past should also
check with a physician before taking them again.
Women who are pregnant or who plan to become
pregnant should check with their physicians before
taking these medicines. Whether nonsteroidal
anti-inflammatory drugs cause birth defects in
people is unknown, but some do cause birth defects
in laboratory animals. If taken late in pregnancy,
these drugs may prolong pregnancy, lengthen labor
time, cause problems during delivery, or affect the
heart or blood flow of the fetus.
Some nonsteroidal anti-inflammatory drugs pass
into breast milk. Women who are breastfeeding should
check with their physicians before taking these
drugs.
A number of medical conditions may influence the
effects of nonsteroidal anti-inflammatory drugs.
Anyone who has any of the conditions listed below
should tell his or her physician about the condition
before taking nonsteroidal anti-inflammatory drugs.
- stomach or intestinal problems, such as
colitis or Crohn's disease
- liver disease
- current or past kidney disease; current or
past kidney stones
- heart disease
- high blood pressure
- blood disorders, such as anemia, low
platelet count, low white blood cell count
- bleeding problems
- diabetes mellitus
- hemorrhoids, rectal bleeding, or rectal
irritation
- asthma
- Parkinson's disease
- epilepsy
- systemic lupus erythematosus
- diseases of the blood vessels, such as
polymyalgiarheumatica and temporal arteritis
- fluid retention
- alcohol abuse
- mental illness.
People who have sores or white spots in the mouth
should tell the physician about them before starting
to take nonsteroidal anti-inflammatory drugs. Sores
or white spots that appear while taking the drug can
be a sign of serious side effects.
Some nonsteroidal anti-inflammatory drugs contain
sugar or sodium, so anyone on a low-sugar or
low-sodium diet should be sure to tell his or her
physician.
People who smoke cigarettes may be more likely to
have unwanted side effects from this medicine.
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USE OF
CERTAIN MEDICINES
Taking nonsteroidal anti-inflammatory drugs with
certain other drugs may affect the way the drugs work or
increase the risk of unwanted side effects. (See
Interactions.)
Side effects
The most common side effects are stomach pain or
cramps, nausea, vomiting, indigestion, diarrhea,
heartburn, headache, dizziness or lightheadedness, and
drowsiness. As the patient's body adjusts to the
medicine, these symptoms usually disappear. If they do
not, check with the physician who prescribed the
medicine.
Serious side effects are rare, but do sometimes
occur. If any of the following side effects occur, stop
taking the medicine and get emergency medical care
immediately:
- swelling or puffiness of the face
- swelling of the hands, feet, or lower legs
- rapid weight gain
- fainting
- breathing problems
- fast or irregular heartbeat
- tightness in the chest
Other side effects do not require emergency medical
care, but should have medical attention. If any of the
following side effects occur, stop taking the medicine
and call the physician who prescribed the medicine as
soon as possible:
- severe pain, cramps, or burning in the stomach
or abdomen
- convulsions
- fever
- severe nausea, heartburn, or indigestion
- white spots or sores in the mouth or on the lips
- rashes or red spots on the skin
- any unusual bleeding, including nosebleeds,
spitting up or vomiting blood or dark material
- black, tarry stool
- chest pain
- unusual bruising
- severe headaches
A number of less common, temporary side effects are
also possible. They usually do not need medical
attention and will disappear once the body adjusts to
the medicine. If they continue or interfere with normal
activity, check with the physician. Among these side
effects are:
- gas, bloating, or constipation
- bitter taste or other taste changes
- sweating
- restlessness, irritability, anxiety
- trembling or twitching
Interactions
Nonsteroidal anti-inflammatory drugs may interact
with a variety of other medicines. When this happens,
the effects of the drugs may change, and the risk of
side effects may be greater. Anyone who takes these
drugs should let the physician know all other medicines
he or she is taking. Among the drugs that may interact
with nonsteroidal anti-inflammatory drugs are:
- blood thinning drugs, such as warfarin (Coumadin)
- other nonsteroidal anti-inflammatory drugs
- heparin
- tetracyclines
- cyclosprorine
- digitalis drugs
- lithium
- phenytoin (Dilantin)
- zidovudine (AZT, Retrovir).
NSAIDs may also interact with certain herbal
preparations sold as dietary supplements. Among the
herbs known to interact with NSAIDs are bearberry (Arctostaphylos
uva-ursi), feverfew (Tanacetum parthenium),
evening primrose (Oenothera biennis), and
gossypol, a pigment obtained from cottonseed oil and
used as a male contraceptive. In most cases, the herb
increases the tendency of NSAIDs to irritate the
digestive tract. It is just as important for patients to
inform their doctor of herbal remedies that they take on
a regular basis as it is to give the doctor a list of
their other prescription medications.
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Key Terms
- Anemia
-
A
lack of hemoglobin--the compound in blood that
carries oxygen from the lungs throughout the
body and brings waste carbon dioxide from the
cells to the lungs, where it is released.
- Bursitis
-
Inflammation of the tissue around a joint.
- Colitis
-
Inflammation of the colon (large bowel.
- COX-2
inhibitors
-
A
class of newer NSAIDs that are less likely to
cause side effects in the digestive tract. COX-2
inhibitors work by inhibiting the production of
cyclooxygenase-2, an enzyme involved in
inflammation.
- Inflammation
-
Pain, redness, swelling, and heat that usually
develop in response to injury or illness.
- Salicylates
-
A
group of drugs that includes aspirin and related
compounds. Salicylates are used to relieve pain,
reduce inflammation, and lower fever.
- Tendinitis
-
Inflammation of a tendon, which is a tough band
of tissue that connects muscle to bone.
