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Non-steroidal anti-inflammatory medications

May 25, 2024 | by Freya Parker

How NSAIDs function

The body produces prostaglandins, which are hormone-like substances that increase body temperature and dilate blood vessels, causing redness and swelling where they are produced. Prostaglandins also contribute to fever, pain, and inflammation.

NSAIDs work by inhibiting cyclooxygenase, also known as COX, an enzyme that the body needs to produce prostaglandins. NSAIDs help ease the discomfort of fever and lessen inflammation and pain by decreasing prostaglandin production.

NSAID side effects

NSAIDs are useful in reducing inflammation, fever, and pain, but they can also have unintended side effects.

NSAIDs frequently result in digestive side effects include indigestion, upset stomach (including nausea or feeling sick), or stomach discomfort. Additionally, using NSAIDs might result in bleeding and ulcers in the stomach and other gastrointestinal tract (gut) areas.

Raised liver enzymes (seen by a blood test; this is more frequently linked to diclofenac than other NSAIDs) are another typical adverse effect of NSAIDs.

headache from diarrhea


salt and liquid storage

elevated blood pressure.

Less frequent adverse effects include:

 oesophageal reflux disease (food pipe) ulcers

discomfort in the rectum (if suppositories are used)

cardiac dysfunction

hyperkalaemia, or elevated blood potassium levels

less uncertainty about kidney function

bronchospasm (breathing difficulties)

skin rash reddening, itching, irritation, or rash (if skin care items, including creams, are applied).

Even in healthy individuals, NSAIDs (except from low-dose aspirin) may raise the risk of heart attack and stroke.

In general, the likelihood of experiencing severe side effects is decreased when NSAIDs are taken infrequently as opposed to daily and at the lowest dose feasible. Speak with your physician or pharmacist if you have any questions or concerns regarding your potential for NSAID side effects.

Until your doctor tells you otherwise, take paracetamol for mild to moderate pain and fever before taking an NSAID since it has fewer side effects.

An NSAID applied topically (as a cream, gel, or ointment) may be sufficient to reduce inflammation and pain in the muscles and joints, as well as ease soreness from sprains or strains.

If applying a topical NSAID doesn’t initially relieve your discomfort, you might want to think about taking an oral NSAID.

NSAIDs may offer comfort.

Even though NSAIDs have a wide range of possible adverse effects, some of which could be dangerous or even fatal, they can also be very helpful if prescribed properly and taken as directed. To be sure taking an NSAID is the best course of action for you, your doctor can assist you in weighing the advantages and disadvantages of doing so.

Always take NSAIDs with caution, for the shortest amount of time, and at the lowest dosage that works for you. Make careful to schedule regular checkups with your doctor if you will be using these medications for an extended period of time (e.g., to treat arthritic symptoms when other treatments are ineffective or when you are taking low-dose aspirin to avoid a heart attack or stroke).

If you are dehydrated, avoid using NSAIDs since you may be more susceptible to adverse effects.

NSAID high-risk populations

NSAID use puts some persons at higher risk of experiencing major side effects. Among the risk factors are:

advancing age (those 65 and older are more likely to experience adverse effects)

asthma digestive issues, bleeding, ulcers, or Helicobacter pylori infection (the bacteria that can cause ulcers) in the past or present

having specific cardiac conditions (heart failure, for example), hypertension, diabetes, or kidney disease

consuming alcohol

using NSAIDs in excessive dosages

NSAID allergies in the past; using specific other medications while taking NSAIDs; using NSAIDs for longer than a few days at a time.

Before purchasing or using an NSAID, let your doctor or pharmacist know if you have any of the aforementioned risk factors. They can talk to you about your risk of side effects and recommend whether an NSAID is right for you.

Avoid using NSAIDs if you are:

allergic to NSAIDs, such as aspirin; bleeding from a gastrointestinal ulcer; planning a pregnancy; or experiencing pregnancy symptoms.

If you’re not sure if you should stop taking NSAIDs, consult your doctor.

NSAID interactions with medications

NSAIDs may have unfavorable interactions with other medications. As an illustration:

When taken alongside medications that thin the blood, such warfarin, NSAIDs raise the chance of bleeding.

When NSAIDs are taken with ACE inhibitors (drugs used to treat high blood pressure and heart problems) and diuretics (drugs to eliminate excess fluid), renal failure may result.

NSAIDs can counteract the effects of heart failure and high blood pressure medications, such as beta blockers, ACE inhibitors, and diuretics, and prevent them from functioning as intended.

NSAIDs raise the risk of bleeding or ulcers in the stomach when taken with other NSAIDs (such as low-dose aspirin) or corticosteroid medications (like prednisolone).

The stomach lining may become irritated by alcohol. When taking NSAIDs, frequent or severe alcohol use may raise the risk of bleeding or gastrointestinal harm.

Consult your physician before taking an NSAID if you are taking any other medications as you may be susceptible to side effects.

Some over-the-counter medications may include NSAIDs.

NSAIDs are present in certain over-the-counter medications, such as pain relievers and some cough, cold, and flu remedies.

If you also take an over-the-counter medication that contains aspirin or another NSAID, you may increase your chance of experiencing side effects or an unintentional overdose.

If you’re not sure if an over-the-counter medication is safe for you to take, always check the active ingredient before purchasing it. You may also consult your doctor or pharmacist.

If your doctor does not advise you to use more than one NSAID-containing medication at the same time, do not. Even if you’re taking low-dose aspirin to lower your risk of heart attack and stroke, you should carefully discuss using another NSAID with your physician.

Inform your doctor or pharmacist if you take any over-the-counter NSAIDs, especially if you are starting a new medication or have surgery coming up.

Guidelines for using NSAIDs in general

Don’t take NSAIDs for longer than prescribed by your physician. If you have any of the following side effects, stop taking your NSAID and call your doctor right away:

ankle swelling

breathing difficulties, dark, coffee-colored vomit, and black feces.

Other general advice to consider when using or preparing to use NSAIDs is as follows:

Any additional medical issues you may have, as well as any medications you now take or intend to take, should be disclosed to your doctor and pharmacist. This includes over-the-counter and complementary medications like vitamin supplements and herbal therapies.

If you believe adverse effects from your NSAID may be occurring, consult your doctor.

CTs. Talk to your doctor about your worries. Find out if there are any NSAID substitutes you could try.

Examine several approaches to pain management. Try physical therapy or an alternative medication, such as paracetamol or anti-inflammatory creams, as they may have fewer adverse effects.If you’re overweight, decreasing weight or having surgery may help with persistent joint discomfort.

Your doctor might be able to recommend different medications to assist manage some of the negative effects if you must continue taking NSAIDs.


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