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Non-steroidal anti-inflammatory drugs (NSAIDs) Q&As

Published by Bupa's health information team, December 2008.

Answers to questions about non-steroidal anti-inflammatory drugs (NSAIDs)

This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.

 

What is the best medicine for pain relief - paracetamol, ibuprofen or aspirin?

This depends on who the medicine is for, as well as the type of pain the medicine is being used to treat.

Explanation

Paracetamol, aspirin and ibuprofen are all commonly used medicines, and they have a similar ability to relieve pain.

The non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen are mainly effective against pain associated with inflammation or tissue damage, while paracetamol is thought to have very little, if any, anti-inflammatory action. NSAIDs are therefore more appropriate for pain associated with conditions causing long-term pain and inflammation, such as rheumatoid arthritis.

Paracetamol is often a better option for short-term pain relief and/or a fever, especially in older people, as it is less likely to have side-effects on the stomach or to increase risk of cardiovascular events (such as heart attack and stroke). Paracetamol can also be used in those people who shouldn't take NSAIDs, such as women who are pregnant or breastfeeding, or people who have asthma that is worsened by NSAIDs.

Paracetamol is also usually preferred for children with a high temperature, as it doesn't have so many gastrointestinal side-effects and, unlike aspirin, has not been associated with Reye's syndrome in children. Reye's syndrome is a rare, life-threatening condition that affects the liver in children.

Which painkiller you have is also down to your own personal preference and what works better for you - the amount of benefit you get from a particular medicine may be different to that in somebody else.

Sources

  • Joint Formulary Committee. British National Formulary. 55th ed. London : British Medical Association and Royal Pharmaceutical Society of Great Britain, 2008; 111-117
  • Simon C, Everitt H, Kendrick T. Oxford handbook of general practice. 2nd ed. Oxford: Oxford University Press, 2005
  • Rang H, Dale M, Ritter J, et al. Pharmacology. 5th ed. London: Churchill Livingstone, 2003:244-253
  • NSAIDS prescribing issues. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 28 July 2008
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Can I combine different types of non-steroidal anti-inflammatory drug (NSAID)?

No, you shouldn't take more than one type of NSAID at any one time.

Explanation

Using more than one type of NSAID at the same time can increase your risk of side-effects. However, if you have been prescribed a low dose of aspirin by your doctor for the treatment of heart disease, you may be able to take an NSAID such as ibuprofen for pain relief. Check with your GP first.

Some painkillers may contain a combination of medicines, but these will be two different types of medicine, such as paracetamol or aspirin with a mild opiate (eg co-codamol). These medicines work in different ways, so they can be used safely together.

An NSAID such as ibuprofen can also be taken at the same time as paracetamol for pain relief, if you feel you are not getting enough benefit from either medicine alone. You can take both medicines at the same time, as long as you don't take more than the maximum daily dose of either. Check with your pharmacist or GP if you are at all unsure.

Sources

  • Simon C, Everitt H, Kendrick T. Oxford handbook of general practice. 2nd ed. Oxford: Oxford University Press, 2005
  • Electronic Medicines Compendium. www.emc.medicines.org.uk, accessed 12 August 2008
  • Common cold. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 28 July 2008
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What are COX-2 inhibitors?

COX-2 inhibitors are a newer type of NSAID that have a lower risk of gastrointestinal side-effects. They are used to relieve pain associated with arthritis.

Explanation

NSAIDs work by blocking an enzyme called cyclo-oxygenase (COX). There are two types of COX enzyme - COX-1 and COX-2. The anti-inflammatory action of the NSAIDs is thought to be due to their effects on the COX-2 enzymes, while some of their unwanted effects, such as the side-effects on the stomach and gastrointestinal tract, are due to the COX-1 enzymes.

New medicines have now been developed that only work on the COX-2 enzymes. COX-2 inhibitors licensed for use in the UK include celecoxib and etoricoxib. These medicines have the beneficial, anti-inflammatory effect of the NSAIDs, with fewer gastrointestinal side-effects. However, they have also been associated with an increased risk of cardiovascular events, such as heart attack and stroke.

For this reason, you will only be prescribed a COX-2 inhibitor if you are unable to tolerate normal (non-selective) NSAIDs, and after your doctor has assessed your risk of cardiovascular events. If you are prescribed a COX-2 inhibitor, it will be for the shortest time necessary to control your symptoms, and you will be monitored closely.

Sources

  • Joint Formulary Committee. British National Formulary. 55th ed. London : British Medical Association and Royal Pharmaceutical Society of Great Britain, 2008: 111-117
  • Rang H, Dale M, Ritter J, et al. Pharmacology. 5th ed. London: Churchill Livingstone, 2003:244-253
  • Simon C, Everitt H, Kendrick T. Oxford handbook of general practice. 2nd ed. Oxford: Oxford University Press, 2005
  • Electronic Medicines Compendium. www.emc.medicines.org.uk, accessed 12 August 2008
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This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: December 2008

 

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