Medications - non-steroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory medications are commonly used to manage the pain and inflammation (swelling and redness) associated with some types of arthritis (such as rheumatoid arthritis) and other musculoskeletal disorders.

Non-steroidal anti-inflammatory drugs (NSAIDs) are also used to treat non-inflammatory conditions such as migraine, period pain and postoperative pain. The blood-thinning properties of aspirin are also used to reduce the risk of heart attack and stroke in high-risk patients.

How anti-inflammatory medications work
Prostaglandins are hormone-like chemicals in the body that cause inflammation by raising the local temperature and dilating the blood vessels. Anti-inflammatory medications relieve inflammation and the associated pain by blocking a specific enzyme (called ‘cyclooxygenase’ or COX) that the body needs in order to make prostaglandins. Inflammation cannot develop without prostaglandins.

Side effects
While NSAIDs are effective to relieve pain and inflammation, they can cause unwanted side effects. Gastrointestinal symptoms such as stomach upset and stomach pain may be caused by anti-inflammatory medications. Use of NSAIDs can also cause stomach ulcers. This is mainly because these medicines attack the enzyme that protects the intestines from normal stomach acids.

The anti-inflammatory medications known as COXIBs were developed to reduce the risk of these gastrointestinal side effects. These types of NSAIDS block the enzyme that leads to inflammation but don’t knock out another enzyme that protects the stomach lining against gastric acid. COXIBs are a major advance, but they have not removed the problem and they can still cause gastrointestinal side effects.

Common side effects
Some of the common side effects of anti-inflammatory medications include:

• Nausea
• Indigestion or upset stomach
• Stomach ulcers or bleeding
• Raised liver enzymes
• Diarrhoea
• Headache
• Dizziness
• Salt and fluid retention
• High blood pressure.

• Ulcers of the oesophagus (food pipe)
• Rectal irritation (if suppositories are used)
• Cardiovascular problems (heart failure, heart attack)
• Hyperkalaemia (high levels of potassium in the blood)
• Kidney problems
• Confusion
• Bronchospasm (difficulty breathing)
• Skin irritation, reddening, itching and rash (if used as a cream).

• Blood abnormalities
• Interstitial nephritis (inflamed tubes in the kidney)
• Cystitis (bladder infection)
• Nephrotic syndrome (a range of symptoms related to diseased kidneys)
• Acute renal failure (kidney failure)
• Papillary necrosis (disease where parts of the kidney are destroyed)
• Photosensitivity (being sensitive to light)
• Stevens–Johnson syndrome (serious condition where flu-like symptoms are followed by red skin lesions)
• Epidermal necrolysis (a serious skin condition where the top skin layer separates from other layers of skin)
• Hepatitis (inflamed liver)
• Meningitis (inflammation of the brain)
• Blurred vision
• Tinnitus (ringing in the ears)
• Allergy and asthma.

• Age, since adverse reactions are more common in people 65 years and over
• Medical history of gastrointestinal problems such as ulcers or Helicobacter pylori infection (the germ that can cause ulcers)
• Medical history of particular heart problems
• Diabetes
• Kidney disease
• Taking high doses of anti-inflammatory medications
• Taking more than one anti-inflammatory medication
• Taking certain other drugs while taking anti-inflammatory medications.

• NSAIDs and blood-thinning medications (such as warfarin) increase the risk of serious bleeding from gastrointestinal ulcer.
• NSAIDs can cause kidney failure when they are combined with ACE inhibitors (drugs to reduce blood pressure) and diuretic medications (to remove excess fluid).
• NSAIDs can also block the effects of many drugs including ACE inhibitors, beta blockers (heart medication) and diuretics.
• Cortisone drugs increase the risk of adverse reactions.
• Alcohol irritates the stomach lining – people who regularly drink alcohol while taking anti-inflammatory medications increase their risk of damage to the gastrointestinal tract.

• If you take anti-inflammatory medications, it is very important to tell your doctor and pharmacist about any other drug you take (or plan to take) including over-the-counter drugs and herbal medicines.
• See your doctor if you think your anti-inflammatory medication may be causing side effects.
• Be cautious of long-term or high-dose treatment with anti-inflammatory medication if you are at risk of side effects. Discuss your concerns with your doctor. Ask if there are any alternatives to anti-inflammatory medications that you could try.
• Explore different ways to manage your pain. For example, you could try losing weight, physical therapies, anti-inflammatory creams (that have fewer side effects), pain-killing medications that contain paracetamol, or joint replacement surgery.
• If you need to keep taking anti-inflammatory medications, your doctor may be able to prescribe other drugs to help manage some of the side effects.
• Don’t stop taking your anti-inflammatory medication without your doctor’s knowledge and approval.

• Your doctor
• Pharmacist
• Rheumatologist
• Medicines Line Tel. 1300 888 763
• The Gut FoundationTel. (02) 9382 2749
• Arthritis Victoria Tel. (03) 8531 8000 or 1800 011 041

• Anti-inflammatory medications are commonly used to manage the pain and inflammation associated with arthritis and other musculoskeletal disorders.
• Anti-inflammatory medications can cause serious side effects and even death.
• Anti-inflammatory medications should generally only be used sparingly and for a short time.

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