Overview
NSAIDs (nonsteroidal anti-inflammatory drugs) are one of the most commonly used drug groups in the world. They help to treat acute or chronic pain and fever and decrease inflammation. NSAIDs inhibit enzymes that are responsible for pain and inflammation. As these drugs are used very broadly and frequently, it’s very important to recognize common side effects and contraindications.
Types and forms of NSAIDs
NSAIDs are available in different formulations:
- tablets
- capsules
- liquid for injections
- topical creams and gels
- suppositories
In the U.S., many NSAIDs are over-the-counter (OTC), while others need a prescription.
Common over-the-counter NSAIDs are listed below.
- Aspirin
- Ibuprofen
- Naproxen
Some of the most common prescription-strength NSAIDs include:
- Celecoxib
- Diclofenac
- Fenoprofen
- Indometacin
- Ketorolac
- Meloxicam
- Naproxen
- Ibuprofen
Low doses of ibuprofen and naproxen are available as OTC medications, while high doses are only prescription-strength.
Nonprescription NSAIDs come with lower doses and are suitable for pain relief. The response to the medicine is individual. If low doses are not effective, a clinician may increase the dose. A healthcare provider can help you to find the most suitable NSAIDs for you.
If you take a medicine without consulting with a specialist:
- Do not take more than one NSAIDs simultaneously.
- Do not take OTC NSAIDs with prescription NSAIDs.
- Do not take more than a recommended dose of NSAIDs.
- Do not take NSAIDs for more than three days for fever.
- Do not take NSAIDs for more than ten days for pain.
- Take after a full meal.
- Take with a full glass of water.
Indications
With NSAIDs, healthcare providers treat different symptoms and diseases. Here is the list of NSAIDs’s common indications:
- muscle ache
- arthritis (joint inflammation)
- tendonitis (inflammation of fibrous cords that attach muscles to the bones)
- back pain
- toothache
- menstrual cramps
- headache
- cold and flu
Contraindications
Talk with a healthcare provider before taking NSAIDs if you:
- are over 65 years
- are pregnant or plan on getting pregnant
- are breastfeeding
- have asthma
- have had an allergic reaction to NSAIDs in the past
- have had stomach ulcers, gastritis, or gastrointestinal (GI) bleeding
- have had gastroesophageal reflux disease (GERD)
- have bowel diseases (Crohn’s disease, ulcerative colitis)
- have unmanaged diabetes
- have any problems with your heart, liver, kidneys, blood pressure or circulation
- have had bleeding disorders
- are taking other medications
In these cases the rate of side effects could be higher. A healthcare consultant will choose the most suitable NSAIDs or alternative medications for you.
Children with viral infections should not take aspirin or aspirin-containing products due to the risk of Reye’s syndrome. Reye’s syndrome is a rare, life-threatening condition that affects the brain and liver.
Side effects
Some side effects are temporary, and some are long-lasting. Side effects are more prevalent if you’re taking high doses for a long time, have underlying health issues, and use excessive amounts of alcohol and tobacco. The most common side effects are gastrointestinal:
- gas
- bloating
- heartburn (GERD)
- constipation
- diarrhea
- stomach pain
- nausea and vomiting
- stomach ulcers, which can lead to GI bleeding
Refer to a GP if you have noticed any of these side effects:
GI tract
NSAIDs can increase your risk of bleeding. Bleeding can occur anywhere, but mostly from the GI tract. The risk is higher if you have stomach or gut diseases, bleeding disorders, or take high-dose NSAIDs for a long duration. GI bleeding symptoms are
- bloody vomit or coffee ground-like material in your vomit
- black or tarry stool
- severe stomach pain
- jaundice
Urinary tract
Use of NSAIDs, even in a short period, can harm kidneys, especially if you have underlying kidney disease. Kidney function should be monitored at least once per year if you take NSAIDs for a long time. The signs of kidney damage are:
- cloudy urine (pee)
- blood in urine
- inability to urinate or change in urine amount
- unusual weight gain
- fluid retention (edema)
Nervous system
- blurred vision
- tinnitus (ringing in the ears)
- photosensitivity (hypersensitivity to light)
- severe headache
- difficulty speaking or thinking
- difficulty concentrating
- balance issues
- dizziness
- drowsiness
- tingling sensation in the arms and legs
Allergic reactions
- severe rash, hives, or peeling skin
- itchy skin
- wheezing, trouble breathing, unusual cough
- chest pain, palpitations, rapid heartbeat
- fatigue
- symptoms of the common cold
Severe side effects
Some side effects of NSAIDs are acute and need emergent medical care. Examples include, but are not limited to, heart attack and stroke, acute severe GI bleeding, and anaphylaxis.
Heart attack and stroke
The risk of heart attack and stroke is increased in people with existing cardiovascular diseases. Symptoms of a heart attack are:
- chest pain or pressure
- tachycardia (fast heartbeat) or arrhythmia (abnormal heartbeat)
- trouble breathing
- back, jaw, throat, or arm pain
- sweating, stomach pain, vomiting, or dizziness
Classic symptoms of stroke are grouped in the acronym “BE FAST”. Each letter stands for the thing you should look for:
- BALANCE—trouble walking, loss of balance, stumbling
- EYES—vision disturbances, like blurred, blackened, and doubled vision
- FACE—sudden weakness or drooping of the face, usually on one side
- ARM—sudden weakness or numbness of one or both arms
- SPEECH—speaking difficulties, uncoordinated and slurred speech
- TIME—Time is crucial in stroke treatment.
If you notice any of the above symptoms of stroke or heart attack, immediately call 9-1-1.
Gastrointestinal (GI) bleeding
GI bleeding can be acute and accompanied by the signs of shock (severe drop of blood pressure). In this situation you need emergent medical care. Call 9-1-1 if you have symptoms of GI bleeding plus one of these signs:
- low blood pressure
- fainting
- changes in consciousness
- tachycardia (rapid pulse) and arrhythmia (irregular or abnormal heart rhythm)
- decreased urine volume
Anaphylaxis
Anaphylaxis is a severe allergic reaction. Symptoms of anaphylaxis are:
- airway swelling and obstruction
- swollen tongue and throat that lead to breathing difficulties
- shock (severe drop of blood pressure)
- tachycardia (rapid pulse) and arrhythmia (irregular or abnormal heart rhythm)
- cardiac arrest (heart stops beating)
- dizziness, lightheadedness, and loss of consciousness
Call 9-1-1 if you have symptoms of anaphylaxis.
Sources:
UpToDate
FDA
Cleveland Clinic
