Non Steroidal Anti Inflammatory Drugs indigestion

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					Drug information

February 2010
There are many different non-steroidal anti-
inflammatory drugs (NSAIDs), for example
aspirin, ibuprofen, naproxen, indometacin,
diclofenac and ketoprofen. The name means
they reduce pain and stiffness due to
inflammation of the joints, without using
steroids. (You can find out about steroids in
our leaflet ‘Steroid Tablets’.)
The ‘coxibs’, or COX-2-specific NSAIDs, are     Tablets or capsules should be taken with a
a family of drugs that perform the same         full glass of fluid, with or shortly after food,
function as standard NSAIDs in that they        and as directed by your doctor. Some
reduce inflammation, but they are less likely   NSAIDs are taken only once a day (especially
than standard NSAIDs to cause stomach           those in a ‘slow-release’, ‘sustained-release’
upsets, heartburn and indigestion.              or ‘retard’ preparation), while others are
Examples of coxibs include celecoxib (brand     taken 2–3 times a day.
name Celebrex) and etoricoxib (Arcoxia).
                                                Your doctor will advise you about the correct
Why are NSAIDs prescribed?                      dose to take. Usually a low dose is prescribed
NSAIDs are helpful in the treatment of          initially, and then increased if necessary.
arthritis because they relieve pain and
stiffness. They have no long-term effect        For any patient who is prescribed NSAIDs
on the disease. They are often taken in         (including coxibs), doctors have been
addition to simple painkillers.                 advised to use the lowest effective dose
                                                for the shortest period of time.
When and how do I take NSAIDs?
NSAIDs are usually taken as tablets or          How long do NSAIDs take to work?
capsules but many are available as a liquid     NSAIDs work quickly, usually within a few
suspension, as a suppository, or as a topical   hours, although the maximum benefit can
cream or gel.                                   take 2 weeks or sometimes longer.

Tel 0870 850 5000
Arthritis Research UK
Drug information

What are the possible risks or side-effects?   Although the increased risk of heart attack
Possible side-effects of NSAIDs include:       and stroke with NSAIDs is small, NSAIDs are
• stomach upsets                               very unlikely to be prescribed if you have
• heartburn                                    heart disease, if you have had a heart
• indigestion                                  attack or stroke in the past, or if you have
• rashes                                       peripheral vascular disease (circulation
• headaches                                    problems in the limbs, usually in the legs).
• wheeziness                                   You should not take etoricoxib if you have
• fluid retention                              high blood pressure which is not under
• a small increased risk of heart attack       control. Doctors have also been advised to
  and stroke.                                  be cautious about prescribing NSAIDs to
                                               people who have an increased risk of heart
If you develop any new symptoms you            disease, such as people with high blood
should stop taking the drug and tell your      pressure, high cholesterol levels (hyper-
doctor or rheumatology nurse specialist        lipidaemia) or diabetes, or people who
as soon as possible.                           smoke. Further information regarding
                                               associations between NSAIDs, heart attacks
NSAIDs can damage the lining of the            and strokes is currently being researched.
stomach and cause bleeding, particularly if
taken in higher doses or over a long period    Coxibs can cause serious, and sometimes
of time. They should therefore only be         fatal, skin reactions, although these
used with caution and only continue to         reactions are rare. If you are concerned
be used if they are controlling your           about your medication or if you need more
symptoms. You should not take them if          information, talk to your doctor or
you have a history of indigestion or           rheumatology nurse.
stomach ulcers. Drugs known as proton-
pump inhibitors are commonly prescribed        What other treatments could be used
along with NSAIDs to help reduce the risk      instead of NSAIDs?
of side-effects on the stomach.                A number of other drugs are used in the
                                               treatment of arthritis and related conditions
Caution is required in the use of NSAIDs       (see our leaflet ‘Drugs and Arthritis’). Your
if you have:                                   doctor will discuss these other options with
• asthma                                       you.
• high blood pressure
• heart disease                                Will I need any special checks while on
• kidney problems                              NSAIDs?
or if you take warfarin. Your should discuss   Your doctor may wish to take your blood
this with your doctor.                         pressure. Generally speaking, monitoring
Arthritis Research UK
Drug information

blood tests (where a blood sample is taken)   Can I drink alcohol while on NSAIDs?
are not required for people on NSAIDs,        You can drink alcohol in moderation,
although in certain situations these may      although alcohol and NSAIDs can both
be needed.                                    upset the stomach.

Can I take other medicines along with         Do NSAIDs affect fertility or pregnancy?
NSAIDs?                                       NSAIDs are not generally recommended
Some drugs, such as warfarin, interact with   during pregnancy. If you are planning a
NSAIDs, so you should discuss any new         family or become pregnant you should
medications with your doctor before           discuss this with your doctor as soon as
starting them, and you should always tell     possible. Some recent studies suggest that
any other doctor treating you that you are    NSAIDs taken around the time of concep-
taking NSAIDs.                                tion may increase the risk of miscarriage.
                                              Paracetamol does not have this effect.
You should not take NSAIDs if you are
allergic to aspirin. Discuss this with your   What about breastfeeding?
doctor.                                       Some NSAIDs should not be taken while
                                              breastfeeding. The drugs may pass into the
Some NSAIDs, such as aspirin and ibuprofen,   breast milk and could be harmful to your
are available without prescription. It is     baby. Discuss this with your doctor.
unwise to take more than one NSAID at any
one time, and some people should not take     Where can I obtain further information?
NSAIDs at all. Do not take any other over-    If you would like any further information
the-counter preparations or herbal remedies   about NSAIDs, or if you have any concerns
without discussing this first with your       about your treatment, you should discuss
doctor, rheumatology nurse or pharmacist.     this with your doctor, rheumatology nurse
                                              or pharmacist.
What about immunisations?
You can have immunisations while on

Tel 0870 850 5000
Arthritis Research UK
Drug information
Copeman House, St Mary’s Court                     Remember to keep all medicines
St Mary’s Gate, Chesterfield                       out of reach of children.
Derbyshire S41 7TD
                                                   PLEASE NOTE: We have made every effort to
Tel 01246 558033 Fax 01246 558007                  ensure that this content is correct at time of
Email                 publication, but remember that information                        about drugs may change. This information
Registered Charity England and Wales no. 207711,
                                                   sheet is for general education only and
Scotland no. SC041156                              does not list all the uses and side-effects
                                                   associated with this drug. For full details
                                                   please see the drug information leaflet that
                                                   comes with your medicine. Your doctor will
                                                   assess your medical circumstances and draw
                                                   your attention to any information or side-effects
                                                   that may be relevant in your particular case.
                                                   Our drug information is revised annually and
                                                   published at the start of the year.
                                                   Printed on 75% recycled paper. 6248/D-NSAID/10-1

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