Non-steroidal anti-inflammatory drugs (NSAIDS) 

Introduction 

Arthritis

Dominic Arkwright reports on arthritis, a condition that causes pain and inflammation of the joints and bones

Media last reviewed: 27/10/2014

Next review due: 27/10/2016

Aspirin

Aspirin (acetylsalicylic acid) was the first NSAID to be developed in 1897. Aspirin is still widely used in other countries, but in the UK its use as a painkiller has decreased.

This is because other painkillers, such as ibuprofen and paracetamol, are just as effective, or more effective, but with a lower risk of side effects.

Aspirin is no longer used for any chronic conditions, especially in older patients, but is widely available over the counter. It's still considered relatively safe for short-term use in younger adults.

In the UK, low-dose aspirin (75mg) is now mainly prescribed for its ability to prevent blood clotting, which reduces the chance of heart attacks and strokes. The medical term for this use is antiplatelet medication.

Read more about the benefits of low-dose aspirin in thinning the blood.

Pain

What to do about different types of pain, including joint pain, back pain and migraines, and managing long-term pain

Non-steroidal anti-inflammatory drugs (NSAIDs) are a medication widely used to treat a range of conditions.

NSAIDs are used to:

  • relieve pain
  • reduce inflammation (redness and swelling)
  • bring down a high temperature (fever)

Common acute (short-term) conditions that can be treated with NSAIDs include:

Common chronic (long-term) conditions that can be treated with NSAIDs include:

Things to consider when using NSAIDs

NSAIDs are associated with a small increase in the risk of a person experiencing a heart attack, stroke or heart failure. These risks are related to how long they are used for, the dosage and certain types of NSAIDs.

NSAIDs are only used in people who have an existing high risk of developing these types of conditions if there are no suitable alternatives and the medications bring significant benefit.

High-risk groups include:

  • those with a history of previous heart attack, stroke or heart failure
  • people aged 75 or over
  • people with diabetes
  • smokers
  • people with high blood pressure

NSAIDs are also not usually recommended for people who:

  • are pregnant or breastfeeding
  • have a history of significant kidney disease
  • have a history of significant liver disease
  • have active stomach ulcers (a sore in the lining of the stomach), or are at high risk of developing stomach ulcers

Read more about things to consider when using NSAIDs.

For people who are unable to take NSAIDs for medical reasons, the painkiller paracetamol can be used as an alternative. For more severe pain, prescription painkillers, such as codeine or tramadol, can be tried. It can be difficult to find the perfect painkiller for each individual.

In cases of severe inflammation an injection of steroids (corticosteroids) can often help.

Read more about alternatives to non-steroidal anti-inflammatory drugs.

Side effects

Most people take NSAIDs without having any side effects. Short term use is unlikely to cause significant problems, especially in younger patients.

If side effects do occur they usually affect the stomach and intestines (gastrointestinal tract) and can include:

Proton pump inhibitors (PPIs) or H-2 antagonist (medications to suppress stomach acid) are often prescribed in combination with NSAIDs to reduce the risk of stomach ulcer complications for:

  • older patients (aged over 55)
  • people who have had previous stomach ulcers
  • people who need long-term NSAID treatment

Read more about the side effects of NSAIDs.

Interactions

It is very important to read the patient information leaflet that comes with your medication as some NSAIDs can either react unpredictably with other medications, or make them less effective.

For example, it's usually not recommended to take an NSAID if you're also taking medication to prevent blood clots such as low-dose aspirin or warfarin. NSAIDs might still be prescribed by a health professional in certain circumstances.

Read more about potential interactions that can occur with NSAIDs.

Dosage

NSAIDs are available in:

  • tablet or capsule form
  • as a topical treatment (a cream, gel or lotion rubbed into a specific part of the body)
  • eye drops – used to treat eye pain
  • injections

Less commonly, NSAIDs are used as a suppository – a capsule inserted into the rectum (back passage).

NSAIDs that dissolve in water should only be taken long-term if prescribed by a health professional. This is because they contain a lot of sodium, which can increase your risk of high blood pressure or stroke over time.

It's important to strictly follow all of the instructions about the recommended dosage for your particular NSAID. If you exceed the recommended dose, you risk experiencing a wide range of adverse effects, some of which can be serious.

Read more about the recommendations on dosage for NSAIDs.

Names

In Europe, the most commonly prescribed NSAIDs are:

Most of the NSAIDs listed above are generic medicines. This means that their production and distribution is not limited to a single company. Therefore, they are available under a range of different brand names and are cheaper to buy.

Some NSAIDs are available over the counter for short-term use only, without the need for a prescription. These NSAIDs include aspirin, diclofenac, naproxen and ibuprofen.

However, because a medication is available over the counter it does not mean it's safe or suitable for everyone. Again, it's important to read the patient information leaflet that comes with your medication.

It is generally accepted that naproxen is the safest NSAID with regard to heart attacks and strokes, but it's not clear how safe it is for the stomach. Celecoxib is the safest with regard to stomach problems, but it's not clear how safe it is on the cardiovascular system.

It's recommended that people taking NSAIDs try periods of not taking them to see if they're still needed.

Note: Aspirin must not be given to children under 16 unless directed by a doctor. Also, some people with asthma get attacks triggered by aspirin or NSAIDs.




Page last reviewed: 04/06/2014

Next review due: 04/06/2016

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The 1 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Sheena 24 said on 06 October 2012

I didn’t know that I would ever be grateful that I’m allergic to aspirin and all those other NSAIDS, too, but now I am! I have to rely on paracatemol if I’m in pain, but I try not to take that unless I really need it. Don’t know what the US name for paracetamol is, but I understand that it’s not an NSAID.

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