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Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are used to treat pain and inflammation (i.e., swelling, irritation). The pain-relieving effect of these medications does not increase with higher-than-prescribed doses, but high doses can increase side effects.

Due to the risk for severe gastrointestinal and cardiovascular side effects, NSAIDs should only be used as instructed. Side effects generally include stomach upset, bleeding in the stomach, and stomach ulcer.

Elderly patients and patients who have taken NSAIDs for a long time are at increased risk for severe side effects, including heart attack and stroke. Patients who are taking NSAIDs should consult a physician if they experience stomach pain, black stools, or blood in the stool.

Common types of nonsteroidal anti-inflammatory drugs include the following:

• Aspirin (e.g., Anacin®, Bayer®)
• Ibuprofen (e.g., Advil®, Motrin®)
• Naproxen (e.g., Aleve®)
• COX-2 inhibitors

Aspirin is an over-the-counter or prescription medicine that relieves mild pain and also treats inflammation. It is commonly used to treat arthritis, headache, and the common cold.

The development of aspirin came before all other NSAIDs. The first known use of this drug was by Hippocrates in 400 B.C. Aspirin is a salicylate, which is found in plants. The successful marketing of herbal remedies often can be attributed to the salicylate content of plants.

Potential side effects include irritation, ulceration, and bleeding of the stomach and other organs in the gastrointestinal (GI) tract. Buffered aspirin (e.g., Ascriptin®, Bufferin®) are coated to reduce the risk for side effects. Aspirin also can affect kidney function and there is a controversial link between aspirin and Reye's syndrome in children.

Unlike other NSAIDs, aspirin can reduce the risk for heart attack and stroke in patients who have cardiovascular disease and patients who have a history of these conditions.

Ibuprofen (e.g., Advil®, Motrin®) is used to treat mild to moderate pain (e.g., arthritis, menstrual cramps, bursitis, gout, headache, migraine) and fever.

Possible side effects include gastrointestinal irritation and bleeding, iron loss (anemia), and kidney dysfunction. Ibuprofen also may cause drowsiness, dizziness, and blurred vision.

Naproxen (e.g., Aleve®) is used to treat mild to moderate pain, fever, and inflammation. Its common uses include treatment for osteoarthritis, rheumatoid arthritis, psoriatic arthritis, gout, ankylosing spondylitis, menstrual cramps, tendonitis, bursitis, and injuries (e.g. broken bones).

Naproxen works slowly and the pain relief lasts longer than other NSAIDs. Naproxen can produce gastrointestinal tract side effects (e.g., stomach pain, nausea, constipaton), headache, and dizziness.

COX-2 inhibitors are the most recently developed NSAIDs. Anti-inflammatory drugs (e.g., NSAIDs) reduce pain and inflammation by blocking COX-1 and COX-2 enzymes. Blocking the COX-1 enzyme increases the risk for gastrointestinal bleeding and ulceration. Some types of pain (e.g., arthritis pain) can be effectively reduced by blocking only the COX-2 enzyme, reducing the risk for gastrointestinal side effects.

COX-2 inhibitors have been developed to provide an NSAID for long-term use without negative gastrointestinal side effects. These drugs are not stronger than other NSAIDs, and it has not yet been proven that they cause fewer stomach problems.

After being available for a short time, some COX-2 inhibitors (e.g., Bextra®, Vioxx®) were removed from the market when it was discovered that they increased the risk for heart attack, stroke, and skin problems. Celebrex® is the only COX-2 inhibitor that is currently on the market.

Some medicines can be taken with NSAIDs to help reduce the risk for gastrointestinal side effects. These medications include misoprostol (Cytotec®) and a class of drugs called proton pump inhibitors (e.g., Prilosec®, Prevacid®, Nexium®). Misoprostol should not be used by women who are pregnant or who could be pregnant.

Prescription nonsteroidal anti-inflammatory drugs often are more expensive than NSAIDs that are available over-the-counter. These drugs have not been proven to be more effective than over-the-counter NSAIDs, or to have fewer side effects. They may be marketed as being better than other NSAIDs for a particular condition, but in most cases, this has not been proven.

Prescription pain medicines should not be taken with over-the-counter pain medicines, herbal medicines, or dietary supplements without consulting a qualified health care provider.

Prescription NSAIDs include the following:

• Naproxen sodium (Anaprox®)
  
• Flurbiprofen (Ansaid®)
  
• Diclofenac potassium (Cataflam®)
  
• Sulindac (Clinoril®)
  
• Oxaprozin (Daypro®)
  
• Piroxicam (Feldene®)
  
• Indomethacin (Indocin®)
  
• Etodolac (Lodine®)
  
• Meclofenamate (Meclomen®)
  
• Fenoprofen (Nalfon®)
  
• Naproxen (Naprosyn®)
  
• Ketoprofen (Oruvail®)
  
• Mefenamic acid (Ponstel®)
  
• Nabumetone (Relafen®)
  
• Tolmetin (Tolectin®)
  
• Ketorolac (Toradol®)
  
• Diclofenac sodium (Voltaren®)
  

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