NON-STEROIDAL ANTI-INFLAMMATORY DRUGS

(NSAIDS & COXIBS) INFORMATION SHEET

Developed by Andy Thompson MD FRCPC

What are Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)?

NSAIDs are the most widely used type of medication to treat arthritis. They are helpful in relieving pain and swelling in the affected joints. Aspirin (Acetylsalicylic Acid) was the first NSAID to be used. There are over 20 NSAIDs available today.

How do NSAIDs work?

NSAIDs work by blocking enzymes known as cyclooxygenase (also known as COX). The COX enzymes are needed to produce chemicals which cause the swelling and pain of your arthritis. By blocking the COX enzymes, NSAIDs can reduce your swelling and pain and increase your day to day function.

Why am I taking NSAIDs?

Your doctor has prescribed this medicine to help with the following:

1. Reduce the pain and swelling (inflammation) in your joints.
2. Improve your day to day function.

What are the different types of NSAIDs available?

Over the Counter NSAIDs: (Available without a prescription)

• Ibuprofen (Motrin®, Advil®)
• Acetylsalicylic Acid (Aspirin®)

Prescription NSAIDs: These are divided into two categories – the Traditional NSAIDs and the COXIBS.

• Traditional NSAIDs: Examples include Diclofenac (Voltaren®, Arthrotec®), Flurbiprofen (Ansaid®, Froben®), Indomethacin (Indocid®), Meloxicam (Mobicox®), Nabumetone (Relafen®), Piroxicam (Feldene®), Naproxen (Naprosyn®) and Tiaprofenic Acid (Surgam®)
• COXIBS: Examples include Celecoxib (Celebrex®)

How often do I take NSAIDs?

Every NSAID is different. Some NSAIDs are taken once daily while others are taken up to four times a day. Your doctor will advise you of the correct dose to take.

Who should NOT take NSAIDs/COXIBs?

• Patients who have asthma which is made worse when taking Aspirin.
• Patients who have had a recent ulcer in the stomach or small bowel.
• Patients who have kidney or liver disease should use with caution.
• Patients who have significant congestive heart failure.
• Patients who have had a heart attack or stroke or experienced serious chest pain related to heart disease should NOT use NSAIDs or COXIBs
• Patients who have significant congestive heart failure.

Who should BE CAREFUL taking NSAIDs/COXIBs?

• Elderly patients (over age 65).
• Patients who have had a previous stomach ulcer.
• Patients who are taking blood thinners such as Warfarin (Coumadin®).
• Patients who have significant risk factors for heart attack or stroke should be aware that using NSAIDs & COXIBs may increase this risk

What are the differences between the Traditional NSAIDs and the COXIBs?

COXIBs are a new chemical class of NSAIDs. They have been developed to reduce the risk of gastrointestinal ulcers and bleeding.

When will I start to feel the effects of NSAIDs?

Some patients will notice the effects of NSAIDs within the first few hours after taking a dose. In other patients the effects may not be evident for a few days and even up to a week or two after the medicine has been started. If it hasn’t helped by 2 weeks it is unlikely to be of much benefit.

What Medications are safe with NSAIDs?

Your rheumatologist may decide to add other medications to treat your arthritis. Some of the medications which may be safely added to NSAIDs include: Acetaminophen (Tylenol), other DMARDs (i.e. Hydroxychloroquine, Sulfasalazine, Methotrexate, and Gold), and Biologics (i.e. Etanercept, Infliximab, Anakinra).

What are the side-effects of NSAIDs?

In general, NSAIDs are fairly well tolerated.

MORE COMMON side-effects include:

• Bloating, nausea, stomach pain, and heartburn.
• Diarrhea or constipation.

RARE side-effects include:

• Allergic reactions such as skin rashes or wheezing.
• Headaches, dizziness, or ringing in the ears (tinnitus).
• Unusual bruising or bleeding.
• Gastrointestinal Problems: NSAIDs can cause irritation to the lining of the stomach, esophagus, and intestine. Notify your doctor if you notice any black or bloody stools, chronic indigestion or heartburn, or vomiting of blood or “coffee ground” material.
• Fluid Retention: In some patients NSAIDs can cause fluid retention with swelling of the ankles.
• Blood Pressure: In some patients NSAIDs can increase the blood pressure. Your blood pressure should be monitored periodically by your doctor while you are taking an NSAID especially if you have high blood pressure.

How can I help to minimize the side-effects of NSAIDs?

• Take your NSAIDs as prescribed by your doctor.
• Take your NSAIDs with food to help reduce stomach upset.
• Taking a medication to protect the lining of the stomach or using one of the newer COXIBs can be helpful in reducing the risk of serious gastrointestinal side effects.

Do I need to have regular blood tests while taking NSAIDs?

NO, you do not need to have regular blood tests while taking NSAIDs. However, while you are taking NSAIDs, your doctor may order periodic blood tests.

How do I stop the NSAIDs?

You do not need to wean yourself off the NSAIDs. They can simply be stopped. However, your disease may “flare” after you stop the medicine.

What should I do if I miss a dose of NSAIDs?

• If you forget to take your NSAIDs at the usual time but remember later on the same day, take the missed dose immediately.
• If you forgot to take yesterday’s dose, skip yesterday’s dose and take your usual dose for today.

Are NSAIDs safe in Pregnancy?

• It is generally advisable to avoid all medications during pregnancy and while you are trying to become pregnant. However, some NSAIDs may be used safely to treat your arthritis in the first and second trimesters. In general, NSAIDs should not be used in the third trimester.
• Please notify your doctor if you become pregnant while taking NSAIDs.