Important things to know about nonsteroidal anti-inflammatory medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) are familiar to most of us and are often very effective for people with pain resulting from arthritis. Not only do they help to reduce pain, they can help to decrease swelling and inflammation as well. Depending on your symptoms, medical history, and other factors, an NSAID may be your health care provider’s first choice for treating your arthritis-related pain.

There are dozens of different kinds of NSAIDs. Probably the most well-known is aspirin; others include ibuprofen and naproxen. NSAIDs are available over the counter (OTC), or by prescription, when stronger doses or combinations with other medications are necessary. NSAIDs also can be delivered in a number of different ways; as pills and capsules, or topically, meaning that they can be administered through the skin in gels, creams, and patches.

These medications are often widely recommended and readily available, but it’s very important to learn all that you can about them. Side effects can occur when they’re not taken correctly, are taken excessively, or are mixed with other medications. Knowing the risks can help to ensure your safety and good health.

How NSAIDs work

The word “nonsteroidal” refers to the fact that NSAIDs do not contain steroids. Steroids are hormones that exist in your body, and that can also be made artificially. Some steroids (such as prednisone) are very effective at decreasing inflammation, and they can also carry significant side effects, especially with long-term use. NSAIDS are sometimes a good alternative to steroids for decreasing inflammation. They work by blocking chemicals in your body called “prostaglandins.” Prostaglandins are substances that dilate blood vessels and play a role in the inflammation and pain that occurs after the body has had an injury or an irritation.

The American College of Rheumatology recommends NSAIDs instead of the drug acetaminophen for people with osteoarthritis who have moderate-to-severe pain and inflammation because acetaminophen doesn’t have any anti-inflammatory effects. People who haven’t gotten good pain relief from acetaminophen may also benefit from NSAIDs.

Realizing the risks

NSAIDs can be a very safe option for treating pain like arthritis pain. However, while many health care providers recommend using them for a short period only, often at the lowest dose possible, arthritis is a long-term medical condition. A major concern is that, over time, high doses can cause heart and kidney problems, high blood pressure, liver damage, and gastrointestinal problems, specifically ulcers and bleeding.

Aspirin, the “grandfather” of all NSAIDS, is a bit unique because it is also in some cases recommended for people who think they are having a heart attack or who have known heart disease (discuss this with your health care provider). It has been shown to have benefit in guarding against heart attacks and strokes, but also can contribute to ulcers and bleeding so should not be used without consultation with your health care provider.

According to the Food and Drug Administration (FDA), people who should be extra-cautious about using NSAIDs because they’re at high risk for NSAID-related bleeding include those who:

    • Have a history of stomach bleeding, as from an ulcer
    • Are over age 60
    • Consume frequent or large amounts of alcohol
    • Combine one NSAID with other NSAIDs or steroid medications
    • Are at increased risk of bleeding in general, for example, if they’re taking blood-thinning medications

Five steps for safe use

1. Stick to the daily dosage. There are specific directions that apply to both OTC and prescription products. If your health care provider recommends an NSAID, be sure that you understand exactly how many pills you should take each day, how often you should take them, and how to take them. Often, it’s recommended that you take them with food. If you do not feel better, do not increase the dosage on your own, as this could result in damage to your kidneys and stomach. Instead, tell your health care provider that your pain hasn’t improved and review your current treatment plan together.

2. Share information. Tell your health care provider about any other OTC or prescription medications that you’re taking, including those not for arthritis. Many medications, such as prescription blood thinners, contain ingredients that shouldn’t be mixed with an NSAID. In general, taking NSAIDs with certain medications may cause or increase side effects and/or decrease the effectiveness of the drugs. Ask your health care provider what you should avoid.

Check in, too, about the dangers of taking more than one NSAID at once. For example, your health care provider may advise against taking a daily aspirin for heart-attack prevention and an OTC or prescription NSAID. Similarly, using a topical NSAID, such as a pain-relief patch or cream, at the same time as taking an NSAID pill may increase the chances of serious side effects.

Even if you use any of these products only occasionally, let your health care provider know. If you’re about to start taking one, be sure to consult provider or pharmacist beforehand.

3. Know what you take. To avoid the possibility of overdose if you’re taking more than one NSAID, it’s important to read the labels of all your medications. For instance, NSAIDs are often ingredients in cough, cold, and sinus products. Ask your health care provider or pharmacist for a list of what to look for under “active ingredients” on the product’s packaging.

4. Watch your alcohol intake. People who take NSAIDs and drink more than three alcoholic beverages per day (two, for women) may be at higher risk for liver disease. Even if you drink less than this, there may be special considerations regarding your consumption of alcohol and NSAIDs. Ask your provider what’s best for you.

5. Know your risk. Each person is unique, and you may have factors in your medical history that put you at higher risk with NSAID use. Talk to your provider about what symptoms or side effects should concern you. Above all, always let your health care team know how you’re feeling and what you’re taking to ensure safe and effective NSAID use.