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Non-steroidal anti-inflammatory drugs (NSAIDs)

Published by Bupa's health information team, April 2009.

This factsheet is for people who are taking non-steroidal anti-inflammatory drugs (NSAIDs), or who would like information about them.

Non-steroidal anti-inflammatory drugs, more commonly called NSAIDs, relieve pain, reduce inflammation and lower a high temperature. Examples of NSAIDs include ibuprofen and aspirin.

Why would I take NSAIDs?
How do NSAIDs work?
How to take NSAIDs
NSAIDs for children
Special care
Side-effects of NSAIDs
Interactions of NSAIDs with other medicines
Names of common NSAIDs
Further information
Questions and answers
Related topics
Sources

Why would I take NSAIDs?

You might take NSAIDs to relieve mild to moderate pain caused by:

headache
backache
toothache
period pains
pain after surgery
sports injuries

NSAIDs (pronounced "en-sayds") also lower a fever if you have a cold or flu, and because they also reduce inflammation, many people take NSAIDs for osteoarthritis and other joint diseases.

Your doctor may recommend that you take a small dose of aspirin (75mg daily) if you have, or are at risk of having, coronary heart disease.

How do NSAIDs work?

NSAIDs block the production of chemicals in the body known as prostaglandins. These chemicals are part of the body's defences, and are involved in sending pain signals to your brain when there is inflammation and tissue damage.

NSAIDs also block another chemical in your body (an enzyme) that helps to make prostaglandins. This enzyme is called cyclo-oxygenase (COX). There are two different types of COX, called COX-1 and COX-2. So NSAIDs are also 'COX inhibitors'.

How to take NSAIDs

You can buy oral ibuprofen (taken by mouth), without a prescription from pharmacies, and from other shops, in packs of up to 16 tablets. Examples include Advil, Cuprofen, Ibuleve, Nurofen and many own-brands. NSAIDs are usually taken by mouth (orally) as tablets, capsules or liquid. If you're in hospital, you may be given NSAIDs as injections or suppositories.

You should take oral NSAIDs with or after food or milk, as this makes it less likely that the NSAIDs will cause stomach problems.

You shouldn't exceed the dose recommended on the packet. For ibuprofen this is 400mg (usually two 200mg tablets), every eight hours in adults. Many cold and flu remedies also contain ibuprofen, sometimes in combination with other medicines such as codeine or a decongestant.

NSAIDs also come as creams and gels that you rub into your skin for joint or muscle pain. You can rub these gently into the affected area to relieve pain, three or four times a day for up to a week. You shouldn't apply them to broken or infected skin, near your eyes or mouth, under plasters or dressings, or in the same place as other skin creams or lotions.

Most other NSAIDs are only available on prescription from your GP. There are many different types of NSAID and not all of them work equally well for everybody. You may need to try several types to find one that suits you best.

Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

NSAIDs for children

A liquid form of ibuprofen, containing 100mg of the medicine per 5ml (for example, Nurofen for Children or Calprofen Infant Suspension), can be given to children over three months old if they weigh at least 5kg (11 pounds). It may also be given to younger babies on the advice of your GP. Most other NSAIDs shouldn't be given to children under 12. Ask your pharmacist for advice.

Always read the patient information leaflet that comes with your child's medicine and if you have any questions, ask your pharmacist for advice.

Special care

Ask your pharmacist before taking an oral NSAID if you:

have asthma
are over 65
have poor kidney or liver function
get indigestion or have ever had a stomach or duodenal ulcer
are pregnant or breastfeeding

You shouldn't take NSAIDs if you have coronary heart disease unless they have been prescribed by your GP. This is because certain NSAIDs, called COX-2 inhibitors - which specifically block one type of COX - can increase your chances of having a heart attack or stroke.

If you have ever had a stomach or duodenal ulcer, you should only take NSAIDs if they are specifically recommended to you by your doctor who is aware of the type and cause of your ulcer. You may have to take additional medicines (such as proton pump inhibitors) to protect your stomach from possible side-effects of the NSAID.

Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Side-effects of NSAIDs

Side-effects are the unwanted, but mostly mild and temporary effects of a successful treatment.

You're unlikely to get side-effects from taking ibuprofen occasionally for pain relief.

If you have to take prescription-only NSAIDs regularly, you may get some of the following side-effects, especially if you're over 65. These include:

indigestion
heartburn
feeling sick or vomiting
diarrhoea
bleeding and ulceration in the stomach

Other, less common, side-effects of NSAIDs include:

ankle swelling
headache
dizziness
a sensation of spinning (vertigo)
ringing in the ears (tinnitus)
unusual bruising or bleeding

NSAIDs can also make asthma worse.

NSAIDs in the form of creams and gels can cause reddening, smarting, itching and skin rashes when rubbed on your skin.

Tell your GP or pharmacist if you develop any of these, or other side-effects. You should contact your GP immediately if you:

have stomach pains or cramps
vomit blood or something that looks like coffee grounds
have bloody or black, tar-like and strong-smelling faeces (stools)

These may be signs of bleeding from the stomach or intestines.

Interactions of NSAIDs with other medicines

Check with your GP or pharmacist before you take any other medicines or herbal remedies at the same time as an NSAID. In particular, some NSAIDs increase the blood-thinning effects of a medicine called warfarin, which is used for treating heart problems and blood clots in the veins.

Names of common NSAIDs

Examples of the main types of NSAIDs are shown in the tables.

You may have noticed that your medicine has two or more names. All medicines have a generic name, which is its official medical name. Many medicines also have at least one brand name, which is the trade name. Generic names are written in lower case and brand names start with a capital letter.

Generic names	Examples of common brand names
diclofenac sodium	Voltarol Emugel, Pennsaid
felbinac	Traxam
ibuprofen	Cuprofen Ibutop Gel, Deep Relief, Fenbid Gel, Ibugel (various formulations), Ibuleve, Ibumousse, Ibuspray, Mentholatum Ibuprofen Gel, Proflex, Radian-B Ibuprofen Gel
ketoprofen	Oruvail, Powergel
piroxicam	Feldene P Gel

Names of common non-prescription creams and gels for your skin (topical NSAIDS)

Generic names	Examples of common brand names
aceclofenac	Preservex
acemetacin	Emflex
aspirin	many brand names
azapropazone	Rheumox
celecoxib	Celebrex
dexibuprofen	Seractil
dexketoprofen	Keral
diclofenac sodium	Voltarol
etodolac	Lodine SR
etoricoxib	Arcoxia
fenbufen	Lederfen
fenoprofen	Fenopron
flurbiprofen	Froben SR
ibuprofen	many brand names
indometacin (indomethacin)	Rimacid
ketoprofen	Orudis, Oruvail
mefenamic acid	Ponstan
meloxicam	Mobic
nabumetone	Relifex
naproxen	Naprosyn, Synflex
piroxicam	Feldene, Brexidol
sulindac	Clinoril
tenoxicam	Mobiflex
tiaprofenic acid	Surgam SA

Names of common NSAIDs that you take as tablets, capsules or syrup (oral NSAIDs)

Further information

Electronic Medicines Compendium
www.emc.medicines.org.uk