NSAIDs: Non-steroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs

NSAIDs, or non-steroidal anti-inflammatory drugs, are recommended for short-term relief from pain, fever, and swelling or stiffness around your bones and joints.

You should feel some relief within an hour of using NSAIDs, but it can take several days or weeks before you feel the full benefit.

If you’ve been using over-the-counter NSAIDs, such as ibuprofen or aspirin, your doctor may recommend you continue taking them under their guidance, before considering another treatment.

NSAID drugs can cause side effects, particularly if you take them for a long period of time. You are likely to be prescribed a short course of an NSAID at the lowest possible dose to treat your pain.

There are around 20 NSAIDs that are commonly prescribed, these include:

• ibuprofen
• ketoprofen
• fenbufen
• piroxicam
• aspirin
• naproxen
• diclofenac
• indomethacin
• celecoxib
• etoricoxib.

They can be taken as either:

• tablets or capsules you swallow
• a liquid you drink
• a suppository, a medicine you place in your bottom
• a cream, gel, spray, plaster, or mousse you apply to the skin – known as topical NSAIDs.

Your doctor should discuss with you the type of NSAID that’s best for you, and they should arrange regular check-ups to review your progress.

NSAIDs may not be suitable for everyone. The type of NSAID you are prescribed may depend upon other health issues, such as if you:

• are over 65
• might be pregnant or you’re breastfeeding
• have asthma or allergies
• have had a reaction to an NSAID
• have had ulcers or bleeding in your stomach
• have had problems with your heart, liver, kidneys, blood pressure, or circulation
• are taking other medicines
• have had a stroke
• have problems with your stomach, intestines, or bowels such as ulcerative colitis or Crohn’s disease
• problems with your blood pressure, circulation, or bleeding
• have a condition affecting your connective tissue, such as lupus
• experience persistent headaches.

Depending on what’s causing your pain, your doctor may first recommend trying a topical NSAID, such as ibuprofen, ketoprofen, felbinac and piroxicam, as they may cause fewer side effects than tablets.

They are often recommended for treating isolated areas of pain and inflammation caused by osteoarthritis, particularly in the hands and knees.

Topical NSAIDs may not be helpful for people with inflammatory conditions, such as rheumatoid arthritis, because their pain is more widespread.

However, NSAIDs are considered the most effective way of relieving pain and inflammation caused by rheumatoid arthritis.

NSAIDs can cause stomach problems so your doctor is likely to prescribe a drug called a proton-pump inhibitor (PPI), such as omeprazole or lansoprazole, to reduce the amount of acid in your stomach.

Some NSAIDs, such as celecoxib, etoricoxib, are designed to be gentler on your stomach.

Depending on your condition, you may be prescribed other drugs, such as disease-modifying anti-rheumatic drugs (DMARDs) or steroids. These drugs can help reduce your pain by treating the condition that’s causing it.

You can use NSAIDs if you are taking paracetamol. However, you should be careful taking NSAIDs with compound painkillers because some compound painkillers contain NSAIDs.

If you have concerns about taking NSAIDs seek advice from a healthcare professional.

NSAIDs risks and side effects

If you’re taking anti-coagulant drugs to thin your blood, such as low-dose aspirin or warfarin, you’re best to avoid taking other NSAIDs or compound painkillers.

Even at low doses, NSAIDs can cause side effects, such as:

• headaches
• dizziness
• stomach pains, sickness, diarrhoea, and indigestion
• bleeding
• swollen ankles
• problems when you pee
• chest pains and difficulty breathing
• a rash or sensitivity to sunlight.

If you experience any side effects, stop taking the pain relief and speak to your doctor.

Long-term use of NSAIDs, can cause problems with the liver, kidney, heart and blood circulation.

NSAIDs can cause stomach problems and are best taken with food or a drink of milk to help reduce these side effects.

If you’re aged over 65, some NSAIDs can increase your risk of developing stomach ulcers. If you’re at risk of developing stomach problems or you get stomach pains after you’ve taken your NSAIDs, speak to your doctor.

NSAIDs can cause side effects and their long-term use should be monitored by a healthcare professional.

Effect of NSAIDs on other treatments

Many people with arthritis and related conditions will need to take painkillers or NSAIDs, along with drugs that treat the underlying cause of their condition. The combination you take and the length of time you take them for will depend on your condition.

For inflammatory types of arthritis, such as rheumatoid arthritis, your doctors should recommend starting treatment with a disease-modifying anti-rheumatic drug (DMARD), such as methotrexate.

DMARDs won’t stop your pain straight away, but once they start to work, you should be able to reduce or stop your pain relief drugs.

If you have gout, you may be prescribed the anti-inflammatory drug colchicine or an NSAID to deal with the pain and swelling from an attack. Aspirin may make your gout worse. You may need to take another drug, such as allopurinol or febuxostat, in the longer term to reduce the risk of having more gout attacks.

If you have osteoarthritis of the hand or knee, you can use capsaicin cream to treat the affected joints several times a day, as well as taking painkillers.

If you’re taking medications for other conditions, you should speak to your doctor or a pharmacist about possible interactions.

Alcohol and NSAIDs

Most people who take painkillers or NSAIDs can drink alcohol in moderation.

Alcohol can increase the risk of side effects of some painkillers and NSAIDs. It’s a good idea to read the leaflet that comes with your drug to see what it says about drinking alcohol.

Fertility, pregnancy, and breastfeeding if you're taking NSAIDs

If you’re planning to start a family or you become pregnant, you should discuss your medication with your doctor as soon as possible.

Paracetamol is usually the recommended pain relief option if you’re pregnant or breastfeeding, but it’s a good idea to talk to your healthcare professional about any medications.

NSAIDs are not usually recommended in pregnancy, especially after 30 weeks, unless you’re advised to take them by your doctor.

In rare cases, low-dose aspirin may be continued during pregnancy but only under specialist care for severe conditions, including:

• high blood pressure
• certain other long-term conditions - such as lupus.

NSAIDs are considered safe to take if you are breastfeeding.

It’s a good idea to talk to your healthcare professional about any medications.