Nonsteroidal anti-inflammatory drugs (NSAID) are the most commonly prescribed drugs in the world. Generally they are safe medications and they are often available as over-the-counter (OTC) items. The risks and benefits of these drugs are often misunderstood. Taking too much is common; not taking enough to be effective may also be an issue. The directions on how to take the drugs do vary depending on the exact compound. Furthermore, every drug has different strength, so a small amount of one drug could be stronger than a big pill of another one. Lastly, some drugs have unique delivery systems, such as they are available in creams to put on the skin.
Medications like aspirin, ibuprofen, naproxen and diclofenac are the most common NSAIDs that are used and available OTC. Acetaminophen (Tylenol) is not a NSAID since it does not have any anti-inflammatory activity. NSAIDs inhibit cyclooxygenase (COX) enzymes, and these affect the making of certain prostaglandins and thromboxanes, leading to their anti-inflammatory abilities.
Inflammation is a cause of pain in many ailments, like osteoarthritis, rheumatoid arthritis, headaches, low back pain, and many causes of muscle and joint pain. Using a medication that blocks inflammation therefore often diminishes pain. If one has ongoing muscle or joint pain, these medications may be helpful. If your pain is due to nerve damage or irritation, like a disc bumping a nerve, or nerve trauma and damage, NSAIDs often do not help. Some of these NSAIDs come in crèmes, especially aspirin, and diclofenac, and using them on painful muscles and joints every four hours as needed can be extremely helpful with little or no risk overall to your health.
These medications have been thought to increase the risk of heart disease, especially the risk of a heart attack or stroke. Vioxx was an anti-inflammatory that was pulled from the market because it did increase the risk of heart attacks. Celebrex is very similar to Vioxx in how it works and there was concern it had some of the same risks related to heart attacks. Ibuprofen, aspirin, and naproxen are not as selective for just inflammation as Celebrex and have been found not to increase heart attack risk. In November 2016, a huge study reported that looked at the risk of Celebrex compared to the other NSAIDs and found the risk to be fractionally less. The overall risk for taking an NSAID is 0.7% for having a cardiovascular event. What this means is the risk for heart attacks while taking any of these medications is very low.
The most important risks of this class of drugs are the affects on the stomach, kidney, and on hypertension. Nonsteroidal anti-inflammatory drugs as noted above affect prostaglandins and thromboxane, and these compounds in the body can affect bleeding and blood clots. Taking NSAIDs can irritate the stomach causing pain and bleeding, if this happens, the medications should be stopped and your doctor told about the symptoms. If one is taking a medication to thin blood to prevent a blood clot, an NSAID or aspirin can make one prone to bleeding problems and should also not be taken. The changes in prostaglandins caused by the NSAIDs can affect how well the kidneys work, as one gets older, the kidney function may naturally be diminished and these drugs can cause the kidneys to fail. The affect on the prostaglandins also impacts blood pressure in some people. If you have hypertension, these can make the problem worse and may need to be stopped or changed to a different NSAID. In general, these medications do not affect the liver and do not cause liver damage. There are other reactions to NSAIDs but these are less common, if they seem to be causing some sort of medical problem, talk to your doctor.
Thomas Cohn, MD
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