Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
What are NSAIDs?
Non-steroidal anti-inflammatory drugs are a group of medications that are used to reduce pain by reducing inflammation. They reduce swelling and redness and help with mild to moderate pain.
What are NSAIDs used for?
NSAIDs are used to reduce the symptoms for a number of rheumatology conditions. They can be taken in acute flares of arthritis and for chronic pain from conditions such as osteoarthritis. They are available over the counter at pharmacies, however a number of them are only available with a prescription.
How are they taken?
NSAIDs come in a number of forms as listed below:
- Examples include ibuprofen, diclofenac, naproxen, etoricoxib.
- This is the most common form of NSAID.
- Pain relief is often achieved after 1 week, however it can take up to 3 weeks to feel the anti-inflammatory benefits.
- If a single NSAID has only a partial effect, another one can be trialled.
- Other forms
- Gels/ creams
- Examples include ibuprofen or diclofenac gels.
- Fewer general side effects.
- Useful for application to swollen or tender joints.
Possible side effects are listed below. Some side effects are more common in certain NSAIDs, so alternatives can be tried.
- Stomach aches, nausea and diarrhoea
- Stomach ulcers and bleeding (can result in black sticky stools)
- If you are at risk of stomach issues, a medication to protect the stomach is often prescribed at the same time. This is usually a proton pump inhibitor called omeprazole, lansoprazole or esomeprazole.
- Headaches and dizziness
- Small increased risk of heart attacks
Cautions of use
There are a number of occasions where NSAIDs may not be a suitable choice of painkiller.
Interactions with other medications
- Prescribed in combination with oral steroids or blood thinning medications.
- Caution should be placed due to the increased risk of intestinal bleeding.
Contraindications with other conditions
- Age >65 years
- More side effects are associated with older age, NSAIDs if used, should be used with caution.
- Often creams/ gels are used for osteoarthritis as these are associated with fewer side effects.
- History of asthma
- NSAIDs can trigger asthma attacks/ allergies.
- History of stomach ulcer
- Inflammatory bowel disease such as Crohn’s colitis or Ulcerative colitis.
- Heart disease such as high blood pressure, heart attacks and heart failure.
- Previous liver or kidney disease.
- There are no contraindications to taking NSAIDs before and after surgery providing it is not surgery of the gastrointestinal tract.
During pregnancy or breastfeeding
- NSAIDs except cox-2 inhibitors (celecoxib and etoricoxib) can be used intermittently with caution in the first trimester and under review up to week 32. They are safe for use when breastfeeding.
- Due to the risk of stomach upset and bleeding, alcohol use should not exceed the recommended maximum of 14 weekly units.
- There are no contraindications to receiving vaccinations whilst taking NSAIDs.
Versus Arthritis: http://www.versusarthritis.org