NSAIDS
What are NSAIDS?
Non-steroidal anti-inflammatory drugs (NSAIDs) are drugs with little to no risk of addiction, that can help to reduce pain, inflammation, and fever.
NSAIDs are commonly used to manage arthritis (osteoarthritis, rheumatoid arthritis), lupus, ankylosing spondylitis, headaches, sports injuries, and menstrual cramps. NSAIDs are available over-the-counter in the U.S. or at higher strengths by prescription.
How do NSAIDs work?
The body produces enzymes called cyclooxygenases (COX) which in turn produce prostaglandins. There are two types of COX enzymes (COX-1 and COX-2). Both produce prostaglandins that promote inflammation and fever. While inflammation and fever are unpleasant, these symptoms are also important for healing. In addition, COX-1 produces prostaglandins that also play a role in blood clotting, and protecting the lining of the stomach from acid damage.
NSAIDs reduce pain by blocking the COX enzymes throughout the body leading to reductions in inflammation and fever. Unfortunately, blocked COX-1 enzymes can also result in thinner blood (e.g., reduced ability to clot), and unprotected stomach linings (e.g., ulcers and stomach bleeding).
While traditional NSAIDs blocked both COX-1 and COX-2 enzymes, newer NSAIDs called "COX-2 inhibitors" only block the COX-2 enzyme so that inflammation and fever can be reduced without effecting blood clotting and the stomach lining.
What are the names of some NSAIDs?
Traditional NSAIDs
- Aspirin
- Ibuprofen (e.g., Motrin, Advil)
- Naproxen (e.g., Naprosyn, Aleve, Anaprox, Naprelan)
- Oxaprozin (e.g., Daypro)
- Diclofenac (e.g., Cambia, Cataflam, Voltaren-XR, Zipsor, Zorvolex)
- Piroxicam (e.g., Feldene)
COX-2 Inhibitors
- Celecoxib (e.g., Celebrex)
Risks
Short-term side effects of NSAIDS include:
- nausea
- stomach pain
- bleeding and ulcers
Some of the long-term risks of NSAID use include:
- increased risk of cardiovascular problems
- interactions with drugs used to treat heart disease such as blood thinners and antihypertensive drugs
- large doses confer risks of kidney problems
- fluid retention
- high blood pressure
In general, you may want to consult your healthcare provider if you want to use NSAIDs, especially if you are pregnant, have high blood pressure, asthma, or a history of kidney or liver disease. Side effects tend to be greater in older individuals.
Prepared by:
Daniel Clauw, MD
10.1.2019
