NSAIDS: Non-Steroidal Anti-Inflammatory Drugs

What are NSAIDs?

NSAIDs are a family of medications that may be used for a variety of reasons, such as fever, pain and swelling. They are among the most widely used medicines, providing relief of such symptoms.

Many NSAIDs are inexpensive, effective over-the counter (OTC) medications. In rheumatology, NSAIDs are commonly used in patients that have arthritis, whether it is from rheumatoid arthritis, juvenile idiopathic arthritis (JIA), lupus or other diseases.

There are more than 15 different NSAIDs, including Naproxen (Naprosyn), Ibuprofen (like Motrin or Advil), Indomethacin (Indocin) and Celecoxib (Celebrex), among others.

How are NSAIDs given?

With the exception of Ketorolac (Torodol), all NSAIDs are taken by mouth. With the exception of Celecoxib (Celebrex), the other NSAIDs mentioned above come in liquid forms, which may be desirable for young children.

The dosing frequency varies depending on the type of NSAID from once to four times daily.

How do NSAIDs work?

NSAIDs may be sub-grouped into three groups: traditional NSAIDs, COX-2 inhibitors and salicylates.

NSAIDs provide symptomatic relief of arthritis mainly by blocking COX enzymes, which produce prostaglandin, and cause joint inflammation.

Importantly, prostaglandin also has other important roles in the body that include stomach protection and regulation of blood flow in the kidney.

Therefore, when these normal functions of prostaglandin, are blocked by traditional NSAIDs, one may experience side effects, such as stomach discomfort.

Traditional NSAIDs include the common over-the-counter medications such as ibuprofen (Advil), and block both COX-1 and COX-2 enzymes involved in making prostaglandin, which is partially responsible for the pain of arthritis.

COX-2 inhibitors, such as Celecoxib (Celebrex), only block the COX-2 enzyme of prostaglandin, and therefore have less GI side effects. COX-2 inhibitors have not been used as long as the traditional NSAIDs.

Rofecoxib (Vioxx) and Valdecoxib (Bextra) were withdrawn from the market in 2007 due to increased cardiovascular risk and serious skin reactions respectively.

The COX-2 inhibitors are also generally more expensive than traditional NSAIDs. Salicylates include medicines such as aspirin (like Anacin or Bayer). Although effective these medications may have more GI and bleeding side effects.

Overall, unlike many adults, children tend to tolerate NSAIDs with relatively few problems.

Possible side effects

  • Stomach discomfort, heartburn, nausea, vomiting, diarrhea, and stomach ulcer
  • Dizziness, drowsiness, headache
  • Rash
  • Swelling of feet

Uncommon side effects

  • Bleeding
  • Blood clots, heart attacks/strokes
  • Kidney disease
  • Liver disease

This does not include all of the possible side effects of NSAIDs

Special Instructions

  • Different NSAIDs may have specific side effects.
  • The uncommon side effects are far more commonly seen in adult patients with evidence of a pre-existing condition, such as heart or kidney disease.
  • The side effects may increase depending on the dose and frequency of NSAIDs.
  • Your doctor may use higher doses of NSAIDs than “standard therapy”. Do not increase this dose without speaking with your doctor.
  • Because of the possibility of side effects, patients who regularly take NSAIDs should be examined by their doctors at least every 3 months, and have regular blood examinations.
  • NSAIDs may be given on a standard daily basis, or “as needed” if a patient is experiencing pain. If taken on a daily basis it is better to take them at the same time every day.
  • Your doctor may choose to change to a different NSAID since one may work better than another for unclear reasons.
  • NSAIDs should be taken with food.
  • Your doctor may also prescribe a medicine that protects your stomach.
  • Combination NSAIDs may be given, for example ibuprofen (traditional NSAID) with aspirin (salicylates), although with increased risk of bleeding and stomach ulcer. Do NOT combine NSAIDs without speaking with your doctor.

    For example, an arthritis patient taking daily Naproxen (Naprosyn) should NOT take another NSAID such as Ibuprofen (like Advil), if they develop a headache at the end of the day. Another type of medication, such as acetaminophen (Tylenol) may be a better choice.

Call your doctor with any question.