Nonsteroidal anti inflammatory drugs, or NSAIDs, are some of the most commonly used medications around the world. They help relieve pain, swelling, and fever. They are available as both over-the-counter (OTC) and prescription medications.

Examples of NSAIDs include aspirin, naproxen, and ibuprofen. NSAIDs target chemicals produced by cells in the body called prostaglandins, which cause the sensation of pain, by affecting the body’s nerve endings. While they provide a number of benefits, these drugs can have serious side effects and can be abused.

NAISDs reduce inflammation, but – as their name implies – they are not derived from steroids, which are substances made from an organic compound called sterol. NAISDs work by preventing cyclooxygenase enzymes in the body, also known as COX enzymes, from working. There are two different types of COX enzymes: COX-1 and COX-2. The COX enzymes increase the production of prostaglandins, compounds that cause inflammation, fever, and the sensation of pain by irritating the nerve endings. When NSAIDs are taken, they reduce the level of prostaglandins in the body and relieve pain. This is helpful for reducing swelling, lowering a fever, and preventing blood clots. NSAIDs are beneficial for many conditions such as arthritis.

Aspirin works by getting into the bloodstream and searching for prostaglandins to inhibit. Ibuprofen actually minimizes the production of prostaglandins produced by the cells. Naproxen serves to block the effects of the prostaglandins themselves.

Ibuprofen is preferred in the relief of pain, swelling, tenderness, and stiffness associated with different types of arthritis, including osteoarthritis and rheumatoid arthritis.

Naproxen is another NSAID that has a longer duration of action than ibuprofen. Besides joint and muscular pain, it is also often used to alleviate pain from sunburns or discomfort from menstrual cramps.

The same active ingredients found in prescription NSAIDs can be found in lower-dose over-the-counter products. As with their prescribed counterparts, OTC NSAIDs such as aspirin, ibuprofen, ketoprofen, and naproxen sodium, should be taken with caution. When taken in excess or for periods that exceed indication, both OTC and prescription-strength NSAIDs can lead to complications such as gastrointestinal inflammation, ulcers, and bleeding. They can also cause elevations in blood pressure and increase propensity to bleed. Some research suggests that NSAIDs can increase the risk of cardiovascular events such as heart attack or stroke as well as dangerous skin reactions.

There are two types of NSAIDs: traditional NSAIDs and COX-2 inhibitors.

Traditional NSAIDs work by blocking both COX enzymes 1 and 2. One function of COX-1 enzymes is to help protect the inner lining of the stomach. Because traditional NSAIDs block COX-1 enzymes, the medication reduces inflammation, but this protective lining of the stomach can be reduced as well. This can lead to side effects such as upset stomach, ulcers, bloating, and stomach bleeding.

COX-2 inhibitors alleviate pain by blocking only the COX-2 enzymes. COX-2 inhibitors pose a comparatively smaller risk for ulcers and gastrointestinal bleeding.

But there are some high risks associated with the use of COX-2 inhibitors. Research has shown that COX-2 inhibitors double the chance of strokes and heart attacks which has led F.D.A. officials to withdraw two COX-2 inhibitors, rofecoxib and valdecoxib, from the market. Celecoxib is the only COX-2 inhibitor available in the United States.

Despite the differences in their modes of treatment, trials comparing the effectiveness of traditional NSAIDs and COX-2 inhibitors have shown both to be equally effective in treating pain and inflammation. Of course, everyone responds differently to different medications; some people may find better relief with one particular NSAID as compared to another.

NSAIDs have a number of mild and more severe side effects.

• Mild side effects include:

• Dizziness

• Headache

• Fatigue

• Diarrhea

• Constipation

• Dry mouth

• Stomach cramps

• More severe side effects include:

• Allergic reaction leading to difficulty breathing, swelling, and hives

• Bleeding ulcers in stomach and/or small intestine

• Bloody stool or urine

• Muscle cramps

• Tinnitus, or ringing in the ears and decreased hearing

• Jaundice skin

Side Effects of COX -2 inhibitors

COX-2 inhibitors can cause many of the same side effects as above, in addition to an increased risk of heart attack and stroke, abdominal pain, flatulence, headaches, nausea, diarrhea, itching, skin rash, water retention, unusual bruising with bleeding, and difficulty sleeping.

Combining different types of drugs can alter the effectiveness of each and change the way the body processes each drug. Side effects from the medications can also intensify. This is called a drug-drug interaction. Drugs can also interact negatively with certain food and drink. This is known as drug-food interaction.

Drinking alcohol after taking NSAIDs increases the risk of stomach bleeding and liver disease. Additionally, vitamins and herbal supplements taken along with medications can affect the drug processing in the body. A person should speak with their doctor regarding interactions before taking NSAIDs.

Proper Use

If NSAIDs are taken as prescribed by the doctor or directed on the label and all instructions are followed as indicated, they can effectively alleviate pain and swelling. Abuse of NSAIDs or neglecting to follow instructions can lead to serious complications. The longer someone takes NSAIDs (as well as the higher the dose taken), the higher the risk that significant side effects or complications will occur. Proper use of NSAIDs is the key to safe and effective treatment.