Non-steroidal anti-inflammatory drugs (NSAIDs)
There are many different non-steroidal anti-inflammatory drugs
(NSAIDs), for example aspirin, ibuprofen, naproxen, indometacin,
diclofenac and ketoprofen. The name means they reduce pain and
stiffness due to inflammation of the joints, without using steroids.
The ‘coxibs’, or COX-2-specific
NSAIDs, are a family of drugs that perform the same function as
standard NSAIDs in that they reduce inflammation, but they are less
likely than standard NSAIDs to cause stomach upsets, heartburn and
indigestion. Examples of coxibs include celecoxib (brand name
Celebrex) and etoricoxib (Arcoxia).
Why are NSAIDs prescribed?
NSAIDs are helpful in the treatment of arthritis because they
relieve pain and stiffness. They have no long-term effect on the
disease. They are often taken in addition to simple
painkillers.
When and how do I take NSAIDs?
NSAIDs are usually taken as tablets or capsules but many are
available as a liquid suspension, as a suppository, or as a topical
cream or gel.
Tablets or capsules should be taken with a full glass of fluid,
with or shortly after food, and as directed by your doctor. Some
NSAIDs are taken only once a day (especially those in a
'slow-release', 'sustained-release' or 'retard' preparation), while
others are taken 2–3 times a day.
Your doctor will advise you about the correct dose to take.
Usually a low dose is prescribed initially, and then increased if
necessary.
For any patient who is
prescribed NSAIDs (including coxibs), doctors have been advised to
use the lowest effective dose for the shortest period of
time.
How long do NSAIDs take to work?
NSAIDs work quickly, usually within a few hours, although the
maximum benefit can take 2 weeks or sometimes longer.
What are the possible risks or side-effects?
Possible side-effects of NSAIDs include:
If you develop any new symptoms you should stop taking the drug
and tell your doctor or rheumatology nurse specialist as soon as
possible.
NSAIDs can damage the lining of the stomach and cause bleeding,
particularly if taken in higher doses or over a long period of
time. They should therefore only be used with caution and
only continue to be used if they are controlling your
symptoms. You should not take them if you have a
history of indigestion or stomach ulcers. Drugs known as
proton-pump inhibitors are commonly prescribed along with NSAIDs to
help reduce the risk of side-effects on the stomach.
Caution is required in the use of NSAIDs if you have:
- asthma
- high blood pressure
- heart disease
- kidney problems
or if you take warfarin. Your should discuss this with your
doctor.
Although the increased risk of heart attack and stroke with
NSAIDs is small, NSAIDs are very unlikely to be prescribed if you
have heart disease, if you have had a heart attack or stroke in the
past, or if you have peripheral vascular disease (circulation
problems in the limbs, usually in the legs). You should not take
etoricoxib if you have high blood pressure which is not under
control. Doctors have also been advised to be cautious about
prescribing NSAIDs to people who have an increased risk of heart
disease, such as people with high blood pressure, high cholesterol
levels (hyperlipidaemia) or diabetes, or people who smoke. Further
information regarding associations between NSAIDs, heart attacks
and strokes is currently being researched.
Coxibs can cause serious, and sometimes fatal, skin reactions,
although these reactions are rare. If you are concerned about your
medication or if you need more information, talk to your doctor or
rheumatology nurse.
What other treatments could be used instead of NSAIDs?
A number of other drugs are used in
the treatment of arthritis and related conditions. Your doctor will
discuss these other options with you.
Will I need any special checks while on NSAIDs?
Your doctor may wish to take your blood pressure. Generally
speaking, monitoring blood tests (where a blood sample is taken)
are not required for people on NSAIDs, although in certain
situations these may be needed.
Can I take other medicines along with NSAIDs?
Some drugs, such as warfarin, interact with NSAIDs, so you
should discuss any new medications with your doctor before starting
them, and you should always tell any other doctor treating you that
you are taking NSAIDs.
You should not take NSAIDs if you are allergic to aspirin.
Discuss this with your doctor.
Some NSAIDs, such as aspirin and ibuprofen, are available
without prescription. It is unwise to take more than one NSAID at
any one time, and some people should not take NSAIDs at all. Do not
take any other over-the-counter preparations or herbal remedies
without discussing this first with your doctor, rheumatology nurse
or pharmacist.
What about immunisations?
You can have immunisations while on NSAIDs.
Can I drink alcohol while on NSAIDs?
You can drink alcohol in moderation, although alcohol and NSAIDs
can both upset the stomach.
Do NSAIDs affect fertility or pregnancy?
NSAIDs are not generally recommended during pregnancy. If you
are planning a family or become pregnant you should discuss this
with your doctor as soon as possible. Some recent studies suggest
that NSAIDs taken around the time of conception may increase the
risk of miscarriage. Paracetamol does not have this effect.
What about breastfeeding?
Some NSAIDs should not be taken while
breastfeeding. The drugs may pass into the breast milk and could be
harmful to your baby. Discuss this with your doctor.
Where can I obtain further information?
If you would like any further information about NSAIDs, or if
you have any concerns about your treatment, you should discuss this
with your doctor, rheumatology nurse or pharmacist.
Remember to keep all medicines out of reach of
children.
PLEASE NOTE: We have made
every effort to ensure that this content is correct at time of
publication, but remember that information about drugs may change.
This page is for general education only and does not
list all the uses and side-effects associated with this
drug. For full details please see the drug information
leaflet that comes with your medicine. Your doctor will assess your
medical circumstances and draw your attention to any information or
side-effects that may be relevant in your particular case.
Our drug information is revised
annually and published at the start of the year.