Anti-inflammatories, non-steroidal

Anti-inflammatories, non-steroidal - Introduction

Non-steroidal anti-inflammatory drugs (NSAIDs) are a medication widely used to treat a range of conditions.

NSAIDs are used to:

relieve pain
reduce inflammation (redness and swelling)
bring down a high temperature (fever)

Widely used NSAIDS are aspirin and ibuprofen (see a list of examples).

Common acute (short-term) conditions that can be treated with NSAIDs include:

headaches
painful periods
toothache
soft tissue injuries such as sprains and strains
infections, such as the common cold or the flu (NSAIDs do not treat the underlying infections, but can help to relieve symptoms; especially fever)

Common chronic (long-term) conditions that can be treated with NSAIDs include:

most types of arthritis, including rheumatoid arthritis, other forms of inflammatory arthritis and osteoarthritis
chronic back pain
chronic neck pain

Things to consider when using NSAIDs

NSAIDs are associated with a small increase in the risk of a person experiencing a heart attack, stroke or heart failure. These risks are related to how long they are used for, the dosage and certain types of NSAIDs.

NSAIDs are only used in people who have an existing high risk of developing these types of conditions if there are no suitable alternatives and the medications bring significant benefit.

High-risk groups include:

those with a history of previous heart attack, stroke or heart failure
people aged 75 or over
people with diabetes
smokers
people with high blood pressure

NSAIDs are also not usually recommended for people who:

are pregnant or breastfeeding
have a history of significant kidney disease
have a history of significant liver disease
have active stomach ulcers (a sore in the lining of the stomach), or are at high risk of developing stomach ulcers

Read more about things to consider when using NSAIDs.

For people who are unable to take NSAIDs for medical reasons, the painkiller paracetamol can be used as an alternative. For more severe pain, prescription painkillers, such as codeine or tramadol, can be tried. It can be difficult to find the perfect painkiller for each individual.

In cases of severe inflammation an injection of steroids (corticosteroids) can often help.

Side effects

Most people take NSAIDs without having any side effects. Short term use is unlikely to cause significant problems, especially in younger patients.

If side effects do occur they usually affect the stomach and intestines (gastrointestinal tract) and can include:

Proton pump inhibitors (PPIs) or H-2 antagonist (medications to suppress stomach acid) are often prescribed in combination with NSAIDs to reduce the risk of stomach ulcer complications for:

older patients (aged over 55)
people who have had previous stomach ulcers
people who need long-term NSAID treatment

Read more about the side effects of NSAIDs.

Interactions

It is very important to read the patient information leaflet that comes with your medication as some NSAIDs can either react unpredictably with other medications, or make them less effective.

For example, it's usually not recommended to take an NSAID if you're also taking medication to prevent blood clots such as low-dose aspirin or warfarin. NSAIDs might still be prescribed by a health professional in certain circumstances.

Dosage

NSAIDs are available in:

tablet or capsule form
as a topical treatment (a cream, gel or lotion rubbed into a specific part of the body)
eye drops ‐ used to treat eye pain
injections

Less commonly, NSAIDs are used as a suppository ‐ a capsule inserted into the rectum (back passage).

NSAIDs that dissolve in water should only be taken long-term if prescribed by a health professional. This is because they contain a lot of sodium, which can increase your risk of high blood pressure or stroke over time.

It's important to strictly follow all of the instructions about the recommended dosage for your particular NSAID. If you exceed the recommended dose, you risk experiencing a wide range of adverse effects, some of which can be serious.

Read more about the recommendations on dosage for NSAIDs.

Examples

In Europe, the most commonly prescribed NSAIDs are:

diclofenac
ibuprofen
naproxen
celecoxib
mefenamic acid
etoricoxib
indometacin
aspirin (in doses greater than 600mg)

Most of the NSAIDs listed above are generic medicines. This means that their production and distribution is not limited to a single company. Therefore, they are available under a range of different brand names and are cheaper to buy.

Some NSAIDs are available over the counter for short-term use only, without the need for a prescription. These NSAIDs include aspirin, diclofenac, naproxen and ibuprofen.

However, because a medication is available over the counter it does not mean it's safe or suitable for everyone. Again, it's important to read the patient information leaflet that comes with your medication.

It is generally accepted that naproxen is the safest NSAID with regard to heart attacks and strokes, but it's not clear how safe it is for the stomach. Celecoxib is the safest with regard to stomach problems, but it's not clear how safe it is on the cardiovascular system.

It's recommended that people taking NSAIDs try periods of not taking them to see if they're still needed.

Note: Aspirin must not be given to children under 16 unless directed by a doctor. Also, some people with asthma get attacks triggered by aspirin or NSAIDs.

Anti-inflammatory: Anti-inflammatory medicines reduce swelling and inflammation.
Fever: A fever is when you have a high body temperature (over 38C or 100.4F).
Inflammation: Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Joints: Joints are the connection point between two bones that allow movement.
Migraines: A migraine is type of recurring headache. It is usually accompanied by nausea, vomiting and sensitivity to light and sound.