Non-Steroidal Anti-Inflammatory Drugs
A DRUG Information Sheet
There are many different non-steroidal anti-inflammatory drugs (NSAIDs), e.g. aspirin, ibuprofen, naproxen, indometacin, diclofenac and ketoprofen. The name means they reduce pain and stiffness due to inflammation of the joints, without using steroids. (You can find out about steroids in the separate arc leaflet 'Steroid Tablets'.)
The 'coxibs', or COX-2-specific NSAIDs, are a family of drugs which perform the same function as standard NSAIDs in that they reduce inflammation, but they are less likely than standard NSAIDs to cause stomach upsets, heartburn and indigestion. Examples of coxibs include celecoxib (brand name Celebrex) and etoricoxib (Arcoxia).
Why am I being prescribed a non-steroidal anti-inflammatory drug (NSAID)?
NSAIDs are helpful because they relieve pain and stiffness. They have no long-term effect on the disease. They are often taken in addition to simple painkillers.
When and how do I take NSAIDs?
They should be taken with or shortly after food and as directed by your doctor. Also you should take a full glass of fluid along with NSAID tablets. Some are taken only once a day (especially those in a 'slow-release', 'sustained-release' or 'retard' preparation). Others are taken 2–3 times a day. They are usually taken by mouth as tablets or capsules. However, many are available as a liquid suspension, as a suppository, or as a topical cream or gel.
What dose do I take?
Your doctor will advise you about the correct dose to take. Usually a low dose is prescribed initially, and then increased if necessary.
For any patient who is prescribed NSAIDs (including coxibs), doctors have been advised to use the lowest effective dose for the shortest period of time.
How long will the NSAID take to work?
NSAIDs work quickly, usually within a few hours, although the maximum benefit can take 2 weeks or sometimes longer.
What are the possible risks or side-effects?
Side-effects of all NSAIDs include stomach upsets, heartburn, indigestion, rashes, headaches, wheeziness and fluid retention. Some NSAIDs, particularly the coxibs, have other important side-effects such as a small increased risk of heart attack and stroke; these are discussed below. If you develop any new symptoms you should stop taking the drug and tell your doctor or rheumatology nurse specialist as soon as possible. NSAIDs can damage the lining of the stomach and cause bleeding, particularly if taken in higher doses or over a long period of time. They should therefore only be used with caution and only continue to be used if they are controlling your symptoms. You should not take them if you have a history of indigestion or stomach ulcers. Some doctors prescribe drugs known as proton-pump inhibitors along with standard NSAIDs to help reduce the side-effects on the stomach.
Caution is required in the use of NSAIDs if you have asthma, high blood pressure, heart disease or kidney problems or take warfarin. Your doctor should advise you about this.
The coxibs have recently been linked to increased risks of heart attack and stroke. Although the increased risk is small, you should not take coxibs if you have heart disease, if you have had a heart attack or stroke in the past, or if you have peripheral vascular disease (circulation problems in the limbs, usually in the legs). You should not take etoricoxib if you have high blood pressure which is not under control. Doctors have also been advised to be cautious about prescribing coxibs to people who have an increased risk of heart disease, such as people with high blood pressure, high cholesterol levels (hyperlipidaemia) or diabetes, or people who smoke. Some standard NSAIDs have also been shown to be associated with a small increased risk of heart attack and stroke, especially when used in high doses and for long periods. Your doctor should take these risks into account and may be cautious in prescribing standard NSAIDs if you have heart disease, a history of stroke or peripheral vascular disease, or if you are at high risk of these diseases. Information regarding this possible increased risk is currently being researched.
Coxibs can cause serious, and sometimes fatal, skin reactions, although these reactions are rare. If you are concerned about your medication or if you need more information, talk to your doctor or rheumatology nurse.
What other treatments could be used instead of NSAIDs?
A number of other drugs are used in the treatment of arthritis and related conditions (see arc leaflet 'Drugs and Arthritis'). Your doctor will discuss these other options with you.
Do I need any special checks while on an NSAID?
Your doctor may wish to take your blood pressure. Generally speaking, monitoring blood tests (where a blood sample is taken) are not required for people on NSAIDs, although in certain situations these may be needed.
May I take other medicines along with an NSAID?
Some drugs, e.g. warfarin, interact with NSAIDs, so you should discuss any new medications with your doctor before starting them, and you should always tell any other doctor treating you that you are taking NSAIDs.
You should not take NSAIDs if you are allergic to aspirin. Discuss this with your doctor.
Some NSAIDs, such as aspirin and ibuprofen, are available without prescription. It is unwise to take more than one NSAID at any one time, and some people should not take NSAIDs at all. Do not take any other over-the-counter preparations or herbal remedies without discussing this first with your doctor, rheumatology nurse or pharmacist.
Can I have immunisations while on NSAIDs?
Yes, you can have immunisations while being treated with NSAIDs.
May I drink alcohol while taking an NSAID?
Yes, in moderation, although alcohol and NSAIDs can both upset the stomach.
Do NSAIDs affect pregnancy?
NSAIDs are not generally recommended during pregnancy. If you are planning a family or become pregnant you should discuss this with your doctor as soon as possible. Some recent studies suggest that NSAIDs taken around the time of conception may increase the risk of miscarriage. Paracetamol does not have this effect.
What about breastfeeding?
Some NSAIDs should not be taken while breastfeeding. Again, discuss this with your doctor.
Where can I obtain further information?
If you would like any further information about NSAIDs, or if you have any concerns about your treatment, you should discuss this with your doctor, rheumatology nurse or pharmacist.
Remember to keep all medicines out of reach of children.
PLEASE NOTE: We have made every effort to ensure that the content of this information sheet is correct at time of going to press, but remember that information about drugs may change. This sheet does not list all the uses and side-effects associated with this drug. For full details please see the drug information leaflet which comes with your medicine. Your doctor will assess your medical circumstances and draw your attention to any information or side-effects which may be relevant in your particular case.
