From 1829, when salicin was isolated from herbal remedy willow bark, NSAIDs have become a very important contribution to pain treatment, when in low doses, and when in high – an inflammation. Though as almost every remedy along with useful health benefits it brings several side effects. Notwithstanding the fact that certain NSAIDs are safer and more effective than others and that they do not produce sedation or respiratory depression (as opiods do) as well as they have very low addiction rate NSAIDs still have some minuses.

NSAIDsare non-steroidal anti-inflammatory drugs with anti-inflammatory, antipyretic and analgesic properties. They reduce pain, inflammation and fever (so, they are not just pain relievers), and prevent blood from clotting to some extend. Sometimes NSAIDs are referred to NSAIAs (non-steroidal anti-inflammatory agents/analgesics), or NSAIMs (non-steroidal anti-inflammatory medicines). The most prominent members of this group of drugs are aspirin ( made by several companies) and ibuprofen (Motrin®, Advil®, Motrin IB®, Nuprin®). Some other well known traditional over-the-counter drugs are naproxen (for example Naprosyn®, Aleve®), nabumetone (Relafen® and others) and COX-2 inhibitors (brand names such as Celebrex). Paracetamol is not an NSAID, unlike many think, though it also has anti-inflammatory properties. All these medications are available without prescription.

NSAIDs are usually proscribed for the treatment of acute or chronic conditions where pain and inflammation are present: for arthritis (rheumatoid, meaning back pain), osteoarthritis, neck pain, inflammatory arthropathies (Reiter’s syndrome, ankylosing spondylitis, psoriatic arthritis), acute gout, metastatic bone pain, pyrexia, dysmenorrhoea, postoperative pain, renal colic, different pain due to inflammation and tissue injury and even for treating headaches and migraine. NSAIDs also have potential for prevention of colorectal cancer and treating cancer and cardiovascular disease.

Despite the fact that NSAIDs are really useful in treating such variety of health problems (according to the study NSAIDs are effective and give good or complete symptom relief) they are associated with a number of side effects. The frequency of side effects varies between the  type of the drug and the term (period) of using.

• Nausea
• Vomiting
• Decreased appetite
• Diarrhea (an increase in the frequency of bowel movements or a decrease in the form of stool)
• Constipation (infrequent stools or hard stools, difficulty passing stools (straining), or a sense of incomplete emptying after a bowel movement)
• Rash
• Heartburn
• Drowsiness
• Dyspepsia (chronic or recurrent pain or discomfort centered in the upper abdomen - 10-20% of NSAID patients experience it)
• Headaches (less common)
• Dizziness (less common)
• Unusual fatigue (less common)

In case any of these effects persist or worsen you should notify your health care provider. Immediately tell your doctor when you experience stomach pain, tinnitus (ringing in the ears), swelling of the feet or ankles, vision changes, joint pain, muscle weakness (or pain), persistent sore throat or fever, oreasy bruising or bleeding. It is also a serious issue for immediate doctor’s consultation in case of changes in amount or color of urine and yellowing of the eyes or skin.

Some others serious side effects (NSAIDs may also cause):

• Fluid retention (leading to edema)
• Photosensitivity (especially 2-arylpropionic acids, piroxicam, diclofenac and benzydamine)
• Kidney failure
• Liver failure
• Ulcers
• Prolonged bleeding after an injury or surgery
• Black stools
• Persistent abdominal (stomach) pain
• Vomit that looks like coffee grounds

They are unlikely to happen, but if these occur – stop taking the medication and consult your doctor or pharmacist immediately.

Some individuals are allergic to NSAIDs and may develop shortness of breath when an NSAID is administered (especially in people who get asthma). If one has an allergy to one NSAID he or she is likely to experience a similar reaction to a different type of NSAID. If an allergic reaction occurs (rash, swelling, itching, dizziness or trouble breathing) stop taking the medication and seek immediate medical attention. Interesting fact about NSAIDs, that they are more likely to cause reddening, smarting, itching and skin rashes when in form of creams and gels (whenrubbed on the skin).

If you have to take NSAIDs regularly, you may get some of the  side-effects, especially if you are over 65. Chronic users are more willing to tolerate adverse events. If taken occasionally (for example ibuprofen for pain relief) you are unlikely to get side-effects from using it.

The American Gastroenterology Association recommends to consult the doctor and to take the decision of NSAIDs proscription rather seriously. About 1% to 4% of NSAID users experience gi (gastrointestinal) complications, as well as some minor cardiovascular ones. Good advise for the patient would be to know (and actually, to indicate) to what group of risk for gi bleeding you are referred to (whether to high or to low). For example if you are in higher risk’s group of GI bleeding you should receive NSAIDs with lower GI risks (such as COX-2 inhibitors), in case you have greater risk of cardiovascular problems – avoid taking COX-2 inhibitors and receive low-dose aspirin (that is known to be cardioprotective).

Some facts to know:

• Be careful with combining different types of NSAIDs (for example if a COX-2 inhibitor is taken, one should not use a traditional NSAID; or in case of daily aspirin therapy - as for reducing cardiovascular risk or colon cancer risk – be careful in using other NSAIDs, as it may block the cardioprotective effects of aspirin).
• Do not use NSAIDs when you are pregnant (particularly during the third trimester). They may cause premature closure of the fetal ductus arteriosus (this is the shunt that protects the lungs from being overworked and allows the right ventricle to strengthen), some other adverse effects and are linked with premature birth. Paracetamol (acetaminophen) is regarded as being safe and well-tolerated during pregnancy (that is not a NSAID but is used for treating almost the same conditions).
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• Avoid taking NSAIDs when you are breastfeeding.
• Do not use these medications if you have a history of stomach ulcers or have liver, heart or kidney problems (at least under close physician supervision).
• Do not use them if you are taking blood thinning medication.
• Be very careful if you have asthma (also strictly under close physician supervision).
• Do not use the aspirin in children and teenagers with chicken pox or influenza as it has been associated with the development of Reye's syndrome.

Now the main goal for the doctors who proscribe NSAIDs is to achieve careful balance between the benefits of the medicine and it potential health complications.

Valentyna Ant.