| Non-steroidal anti-inflammatories (NSAIDs) work by reducing
levels of chemicals associated with inflammation and the communication
of pain signals, particularly prostaglandins. The exact mechanism
that makes this work for pain control, though, is still unclear.
A recent development in NSAID research has produced a type of targeted
anti-inflammatory with fewer side effects. They are referred to
as Cox II (cyclooxygenase) inhibitors, an enzyme associated with
pain and inflammation. Unlike other NSAIDs, they do not inhibit
Cox I, an enzyme which protects the kidneys and the lining of the
stomach. These new medications, Celebrex (celecoxib) and Vioxx (rofecoxib),
are not necessarily better pain relievers than other drugs in this
class but are much less likely to cause undesirable side effects.
NSAIDs are prescribed for a variety of medical conditions, though
primarily for various types of inflammatory pain and arthritis.
The common drug aspirin can be considered an NSAID, and has a similar
side effect and allergy profile. The drugs ibuprofen and naproxen
are available as over the counter remedies. For higher doses of
these remedies, and for all other forms of NSAIDs, a prescription
is required.
These medications may alter the results of certain medical tests.
Be sure to speak to your doctor or laboratory technician in advance
regarding any instructions you should follow. If you go to the emergency
room, or are being treated by emergency medical personnel, be sure
to mention if you have recently taken an NSAID.
Conditions treated by NSAIDs include, but may not be limited to:
- Arthritis or other joint pain
- Bursitis
- Fever
- Gout
- Headache
- Menstrual cramping
- Sprains or other muscle injuries
- Tendinitis
Prescription doses of these medications are often the first type
of analgesic tried when over the counter remedies fail to ease pain.
General Side Effects
One of the most common possible side effects of NSAIDs is gastrointestinal
bleeding. Just like with the over the counter remedy, acetaminophen,
many individuals unknowingly experience slight bleeding from the
stomach walls with each dose of an NSAID. This includes the
over the counter preparations of aspirin, ibuprofen, and naproxen.
The Cox II inhibitors are less likely to cause internal bleeding,
but even though they seem to have a lower rate of side effects over
the short term, they still carry the same riskss as other NSAIDs
with continual use.
If used frequently to treat headache pain, these medications may
cause severe rebound headaches in individuals who are predisposed
to get them. If you have more than four major headaches per month,
you should look into a preventive therapy to reduce the need for
pain medication.
This potential health issue increases in likelihood with dosage
and length of use. If you are prone gastrointestinal bleeding, or
are over 60 years of age, you may be at particular risk. If you
have absorption problems, leaky gut syndrome, or multiple food allergies,
you may want to severely restrict your use of NSAIDs. Individuals
who use these medications often for chronic pain should periodically
be checked by their doctors for anemia, a sign of persistent internal
bleeding.
Other side effects tend to be rare and mild, but you should examine
the warning label on any NSAID if you experience strange symptoms
during treatment.
Cautions: While NSAIDs are generally considered to be safe
and effective treatments for pain, they may not be right for everyone.
Some individuals may want to check with a doctor for safe use guidelines
with a particular condition, or may decide that another treatment
would be more appropriate. Be sure to give your prescribing physician
a complete medical history, being especially sure to mention any
of the following conditions.
- Alcohol Use or Smoking: You are at increased risk for
stomach bleeding when using these medications. Liver damage may
be more likely when combining alcohol and NSAIDs.
- Allergies: If you are allergic to aspirin, you should
not use NSAIDs. There is a possibility of anaphylactic shock,
though a mild skin rash or itching are more likely. If you are
allergic to sulfa drugs, some NSAIDs are compounded with sulfa
chemicals. Your physician can prescribe one that is safe for you.
Also mention any other food or drug allergies you may have experienced,
to be sure that your doctor can prescribe an appropriate medication.
- Asthma: If you have ever had an asthmatic reaction to
aspirin, or any NSAID, you should not use this type of medication
for pain control. You are at increased risk of bronchospasm or
an anaphylactic reaction.
- Bone Marrow Depression: This may be worsened in susceptible
individuals, you may wish to choose a different type of treatment.
- Gastrointestinal Bleeding: Do not use NSAIDs, aspirin,
or acetaminophen, as these medications will all cause additional
bleeding.
- Heart Disease: There are some indications that these
medications should not be used by patients at risk for congestive
heart failure. Speak with your doctor about whether or not this
treatment poses any risks to you.
- Kidney Disease: These medications may worsen kidney damage,
or push stressed kidneys into a diseased state. Ask your doctor
if this treatment is right for you, or if there are dosing guidelines
that would make it safe. Drink 6-8 glasses of water daily to reduce
strain on the kidneys.
- Liver Disease: These medications may cause liver damage,
and stress damaged livers. Speak to your doctor about appropriate
dosage guidelines, or other available pain control methods. Never
combine two different NSAIDs together, or use them with over the
counter pain prescriptions, as this may increase the danger of
liver damage even for healthy individuals. Do not combine alcohol
use with your treatment.
- Porphyria: Some NSAIDs are unsafe medications for porphyria,
always check the warnings with each medication prescribed to you.
- Seizure disorder: NSAIDs may cause toxic build ups of
your antiseizure medications. Check with your doctor or pharmacist
concerning possible interactions. NSAIDs may increase the risk
of seizure in conjunction with certain medications.
- Ulcer: Do not use NSAIDs, aspirin, or acetaminophen,
as these medications will all cause additional stomach bleeding.
These medications may induce ulcers as a side effect, with constant
use for long periods of time, in previously healthy individuals.
Interactions
NSAIDs may interact with other medications you may be taking. The
following drugs are especially likely to interact with these treatments,
but you should always check the labels of each individual medication
you use to decrease the likelihood of undesirable side effects.
If medications increase each others effects, or lead to undesirable
drug build ups in the body, your doctor may recommend adjusting
the dosages of one of the medications if it seems appropriate to
use both treatments.
Medications which increase the risk of kidney or liver damage,
or bleeding, should generally not be combined with NSAIDs without
close medical supervision if at all. If you are taking any of these
medications for a serious condition, it might be best to seek out
a different type of pain control.
- Acetaminophen - Concurrent use increases the likelihood of kidney
or liver damage. Do not combine.
- ACE inhibitors - Increases likelihood of kidney damage, may
lessen pain control effects.
- Alcohol - Do not use alcohol with these treatments, or within
the time frame during which they are effective. This combination
increases the risk of liver damage. Alcohol should be avoided
entirely if you are using NSAIDs and have a liver condition.
- Anticoagulants - Increased risk of bleeding.
- Antihistamines - May lead to NSAID toxicity.
- Antiseizure medication - Increased risk of toxic build up of
antiseizure treatment, or risk of bleeding.
- Anturane (sulfinpyrazone) - Increased risk of bleeding.
- Aspirin - Increases the likelihood and potential severity of
ulcerative or gastrointestinal bleeding. Do not combine.
- Beta Blockers - Effectiveness may be decreased by NSAIDs.
- Cognex (tacrine) - Case report of delirium in combination with
ibuprofen.
- Diuretics - These medications may result in decreased pain control.
- Floroquinolones - These antibiotics may increase the risk of
seizure in combination with NSAIDs.
- Fosamax (alendronate) - May increase stomach irritation in combination
with NSAIDs.
- Heparins like Lovenox (enoxaparin), etc. - Increased risk of
bleeding.
- Indocin (indomethacin) - Increased risk of bleeding.
- Lithium - Lithium toxicity is
possible in combination with these medications.
- Methotrexate - Possible methotrexate toxicity, anemia, blood
infection, or hemorrhage. Do not combine.
- Narcotic pain medication - These treatments may contain the
NSAID ibuprofen, or acetaminophen, neither of which should be
combined with other NSAIDs.
- NSAIDs, other: Do not combine two NSAID treatments with each
other as this increases the risk of damage to the kidneys, liver,
and stomach lining.
- Oral hypoglycemic treatments - Effects may be increased by NSAIDs.
- Persantine (dipyridamole) - Increased risk of bleeding.
- Prograf (tacrolimus) - Serious risk of kidney failure. Do not
combine.
- Protease inhibitors - May cause NSAID toxicity.
- Sandimmune (cyclosporine) - Toxic levels of this medication
may build up in the body.
For maximum safety and effectiveness, follow your
doctor's guidelines when using NSAIDs, and always check the individual
instructions for each medication you may take.
References:
This document is provided for information only; it is not intended
to diagnose symptoms, prescribe treatment, or to substitute for
consultation with a physician. While we have made every effort to
ensure that this information is accurate and extensive, only your
doctor can tell you if a medication, or drug combination, is safe
for you. Information intended for US residents only. |
