NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) and Arthritis

NSAIDs -- nonsteroidal anti-inflammatory drugs -- are a type of pain reliever. At prescription doses, these drugs also reduce inflammation. Inflammation is the body's response to irritation or injury and is characterized by redness, warmth, swelling, and pain. NSAIDs are used to treat a variety of conditions that cause pain and inflammation, including arthritis and tendinitis. NSAIDs are also used to treat pain from injury or other causes of long-term pain.

Over-the-Counter Anti-inflammatory Drugs

NSAIDs that can be purchased without a prescription include:

Advil, Motrin ibuprofen
Aleve naproxen sodium
Ascriptin, Bayer, Ecotrin aspirin

Ibuprofen is also available as a prescription at doses higher than the over-the-counter medications.

Prescription Anti-inflammatory Drugs

How Do NSAIDs Work?

NSAIDs work by blocking the production of certain chemicals in the body that cause inflammation.

Do All NSAIDs Work the Same Way?

There appears to be no fundamental difference in the ability of different NSAIDs to reduce pain and inflammation. However, you might find that you get more relief from one NSAID over another and some NSAIDs may have fewer side effects than others. The effect differs from person to person. Some NSAIDs also may be more convenient, since they only need be taken once or twice a day.

What Are the Common Side Effects of NSAIDs?

The FDA has recently strengthened its warning that NSAIDs cause an increased risk of heart attack and stroke, especially in higher doses. They have also been known to cause stomach bleeding. it is important that you be aware of potential side effects.

NSAIDs are safest when low doses are taken for brief periods. Side effects most commonly occur if you are taking large doses over a prolonged time (months or years). Some side effects are mild and go away on their own or after reducing the dose. Others may be more serious and need medical attention.

Common side effects of NSAIDs include:

  • Stomach pain and heartburn
  • Stomach ulcers
  • Increased bleeding tendency while taking NSAIDs, especially aspirin. Your doctor might tell you to stop NSAIDs before surgery. Ask your doctor before taking NSAIDs if you are on blood-thinning medications (such as Coumadin).
  • Headaches and dizziness
  • Ringing in the ears may result from certain NSAIDs, including aspirin. This can usually be improved by decreasing the dose.
  • Allergic reactions such as rashes, wheezing, and throat swelling
  • Liver or kidney problems. These problems can be evaluated by blood tests in people who take NSAIDs for prolonged periods. People with any kidney problems should not take NSAIDs without checking with their doctor.
  • High blood pressure
  • Leg swelling

Please note: The side effects listed are the most common ones. Not all side effects are included. Always contact your doctor if you have questions about your particular medication or if you are experiencing any unusual side effect.


Who Is More Likely to Develop Stomach Ulcers and Bleeding While Taking NSAIDs?

Anyone can develop a stomach ulcer while taking NSAIDs. But having several of the following factors may raise your risk:

  • Over 60 years old
  • History of stomach ulcers
  • Cigarette smoking
  • Multiple medical problems
  • Three or more alcoholic drinks daily
  • Use of anti-inflammatory steroids, such as prednisone
  • Kidney failure (when taken for longer period of time and/or higher doses)

How Can NSAID Side Effects Be Minimized?

There is no way to completely avoid the side effects of any drug, but you and your doctor can minimize your risk of developing some side effects from NSAIDs. For example:

  • Use acetaminophen (Tylenol) instead of NSAIDs for pain relief that your doctor doesn't feel requires an anti-inflammatory drug.
  • Take the minimal amount of NSAIDs that you need for your condition.
  • Take NSAIDs with food.
  • If you don't need 24-hour a day relief, avoid one-dose-a-day types of NSAIDs, especially if you are over age 60. These medications stay in your system longer and may cause more side effects.
  • Ask your doctor about taking a second drug, such as a stomach acid blocker that can reduce your risk of injuring the stomach. Some medications combine an NSAID and an acid blocker in one pill.

If you have persistent or unusual pain in your stomach after starting an NSAID, tell your doctor right away.

How Are NSAIDs Prescribed?

NSAIDs are prescribed in different doses depending on your condition. Dosages may range from one to four times per day, depending on how long each drug stays in the body. Your doctor may prescribe higher doses of NSAIDs if you have rheumatoid arthritis (RA), for example, because frequently there is a significant degree of heat, swelling, redness, and stiffness in the joints in RA. Lower doses may be adequate for osteoarthritis and muscle injuries, since there is generally less swelling and often no warmth or redness to the joints.

No single NSAID is guaranteed to work. Your doctor may prescribe several types of NSAIDs before finding one that works best for you.


Can I Take NSAIDs If I'm Being Treated for High Blood Pressure?

NSAIDs can raise blood pressure in some people. Some people with high blood pressure may have to stop taking NSAIDs if their blood pressure increases in spite of regularly taking their blood pressure medications.

Are NSAIDs Available Without a Prescription?

Yes. Over-the-counter NSAIDs are available without a prescription in lower doses than comparable prescription NSAIDs. Current over-the-counter NSAIDs include:

  • Aspirin compounds (Anacin, Bayer, Bufferin, Ecotin, and Excedrin)
  • Ibuprofen (Advil and Motrin)
  • Naproxen sodium (Aleve)

Over-the-counter NSAID labels must contain information about the risks of heart attack, stroke, and stomach bleeding. As with any medication, always follow the directions on the label and the instructions from your doctor.

Never use an over-the-counter NSAID continuously for more than 10 days without checking with your doctor. Over-the-counter NSAIDs are effective pain relievers, but they are intended for short-term use. When taking NSAIDs for long periods of time, you should be carefully monitored by your doctor so she can detect side effects and change your treatment if necessary.

Who Should Not Take NSAIDs?

Ask your doctor before taking an NSAID if:

WebMD Medical Reference Reviewed by Jennifer Robinson, MD on September 29, 2015



Arthritis Foundation.



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