Nonsteroidal anti-inflammatory drugs (NSAIDs) are medicines you can take for pain relief. They are often sold over the counter (OTC). This means you can buy them without a prescription from your doctor. Some common brand names are Advil, Motrin, or Aleve. But these medicines are available by prescription, as well.
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How do prescription NSAIDs work?
NSAIDs stop a certain kind of enzyme in your body from working. These are called cyclooxygenase enzymes (also called COX enzymes). COX enzymes speed up your body’s production of hormone-like substances called prostaglandins. Prostaglandins irritate your nerve endings and cause you to feel pain. They are also part of the system that helps your body control its temperature.
By reducing the level of prostaglandins in your body, NSAIDs help relieve pain from conditions like arthritis, muscle sprains, or bone fractures. They also help reduce inflammation (swelling), lower fevers, and prevent blood from clotting.
There are 2 classes of prescription NSAIDs: traditional and COX-2 inhibitors.
Traditional NSAIDs
include:
- Aspirin
- Diclofenac
- Etodolac
- Fenoprofen
- Flurbiprofen
- Ibuprofen
- Indomethacin
- Meclofenamate
- Mefenamic Acid
- Nabumetone
- Naproxen
- Oxaprozin
- Piroxicam
- Sulindac
- Tolmetin
COX-2 inhibitors
include:
- Celecoxib
- Meloxicam
If you need to take a prescription NSAID, your doctor will help you find one that is right for you.
What’s the difference between traditional NSAIDs and COX-2 inhibitors?
You have 2 types of COX enzymes in your body: COX-1 and COX-2. Researchers believe that one of the jobs of COX-1 enzymes is to help protect your stomach lining. The COX-2 enzyme doesn’t play a role in protecting your stomach.
Traditional NSAIDs stop both COX-1 and COX- 2 enzymes from doing their jobs. When COX-1 enzymes are blocked, pain and inflammation are reduced. But the protective lining of your stomach is also reduced. This can cause problems such as upset stomach, ulcers, bloating, and bleeding in your stomach and intestines. Certain NSAIDs may be more likely to cause some of these problems.
COX-2 inhibitors only stop COX-2 enzymes from working. The COX-2 enzyme doesn’t help to protect your stomach. So COX-2 inhibitors may be less likely to irritate your stomach or intestines.
Things to consider
Like all medicines, prescription NSAIDs can cause side effects. However, the side effects usually are not severe and are not experienced very often.
Common side effects of prescription NSAIDs may include:
- Dizziness
- Headache
- Nausea
- Diarrhea
- Excess gas
- Constipation
- Extreme weakness or fatigue
- Dry mouth
Serious, but rare, side effects of prescription NSAIDs may include:
- Allergic reaction (difficulty breathing, hives, and swelling of the lips, tongue, or face)
- Muscle cramps, numbness, or tingling
- Rapid weight gain
- Black, bloody, or tarry stools
- Bloody urine or bloody vomit
- Decreased hearing or ringing in the ears (also called tinnitus)
- Jaundice (the yellowing of the skin and the whites of the eyes)
- Abdominal cramping
- Heartburn
- Indigestion
In addition to the side effects listed above, people taking a COX-2 inhibitor may be at risk for:
- Swelling or water retention
- Skin rash or itching
- Unusual bruising or bleeding
- Difficulty sleeping (insomnia)
Call your doctor as soon as possible if your side effects become severe.
Is it safe to take NSAIDs for a long period of time?
If you take NSAIDs. you increase your risk of developing severe bleeding in your stomach. You may also be at risk for heart attacks and strokes. These risks get worse if you take higher doses. It also gets worse if you take these medicines for a long period of time. If you need to take pain medicine for longer than a week, you should discuss this risk with your family doctor. You may want to explore other pain treatment options.
What is a drug interaction?
If you use 2 or more medicines at the same time, the way your body processes each one can change. When this happens, the risk of side effects from each one increases. Each medicine may not work the way it should. This is called a drug-drug interaction. For example, NSAIDs thin the blood. If you take a blood thinning medicine such as warfarin and you take an NSAID, there could be a drug-drug interaction. Vitamins and herbal supplements can affect the way your body processes medicines, too.
Certain foods or drinks can also prevent your medicine from working the way it should. Or they can make side effects worse. This is called a drug-food interaction. For example, if you’re taking a traditional NSAID, drinking alcohol can increase your risk of liver disease or stomach bleeding.
Drug-drug interactions and drug-food interactions can be dangerous. Be sure that your doctor knows all the medicines you are taking. This includes OTC and prescription medicines, vitamins, and herbal supplements. Also, talk to your doctor before you take any new OTC or prescription medicine, vitamin, or supplement.
It’s important to take medicines exactly as your doctor prescribes. Ask your doctor whether you need to avoid any foods or drinks while using a prescription NSAID.
Two NSAIDs or an NSAID and COX-2 should not be combined. A prescription NSAID or COX-2 should also not be taken with an OTC NSAID. You should be especially careful not to add an NSAID or COX-2 if you already take aspirin.
Questions to ask your doctor
- What is the difference between an OTC NSAID and a prescription NSAID?
- What is the best NSAID for me?
- What are the side effects?
- How long is it safe for me to take a prescription NSAID?
- Are there any drug-drug or food-drug interactions I need to watch out for?
