NSAIDs which stands for nonsteroidal anti-inflammatory drugs are pain relievers that are commonly used around the world. They can effectively relieve pain especially pain associated with inflammation. However, NSAIDs have some risks associated with taking them. This risk increases according to the amount and length of time the person is taking it. While over the counter medications contain low doses of NSAIDs, a study has shown that up to 11% of people taking ibuprofen and 4% of people taking other NSAIDs and this happened on 9.1% of NSAID usage days. If the name If NSAID doesn’t ring a bell, then think of names like ibuprofen or brands like Felvin (piroxicam).
How does NSAIDs work?
Prostaglandins are a major contributor to inflammation in the body. NSAIDs decrease the production of prostaglandins by blocking the enzyme cyclo-oxygenase. This enzyme plays a key role in making prostaglandins and it is of two types cyclo-oxygenase-1 (COX-1) and cyclo-oxygenase-2 (COX-2). COX-1 protects the stomach lining while COX-2 is produced in injured or inflamed sites.
Lists of NSAIDs
Here are some examples of NSAIDs.
- Ibuprofen (Motrin, Advil, Nuprin)
- Dexibuprofen
- Naproxen (Aleve)
- Flurbiprofen (Ansaid)
- Ketoprofen ( Ketoprofen ER, Orudis, Actron, Oruvail)
- Dexketoprofen
- Tiaprofenic acid
- Diclofenac sodium
- Etodolac (Lodine)
- Indometacin (Indocin)
- Mefenamic acid (Ponstel)
- Meloxicam (Mobic Vivlodex)
- Nabumetone (Relafen)
- Phenylbutazone
- Piroxicam (Feldene, Felvin)
- Sulindac (Clinoril)
- Tenoxicam
- Tolfenamic acid
- Ketorolac trometamol
- Aspirin
- Fenoprofen (Nalfon)
- Diflunisal (Dolobid)
- Oxaprozin (Daypro)
- Tolmetin (Tolectin, Tolmetin Sodium)
- Salsalate (Disalcid)
- Ketorolac (Toradol)
- Meclofenamate
Dangers of NSAIDs
Gastrointestinal toxicities including ulcers and bleeding
The most common side effect that all NSAIDs share is that they all cause gastrointestinal disturbances. Aspirin is an NSAID that is well known for causing gastrointestinal bleeding and ulcers. Evidence on the relative safety of NSAIDs suggests variations in the risks of gastro-intestinal side-effects.
NSAIDs with the highest risk of gastrointestinal toxicities including ulcers and bleeding
- Piroxicam
- Ketoprofen
- ketorolac trometamol
NSAIDs with the intermediate risk of gastrointestinal toxicities including ulcers and bleeding
- Indomethacin
- Diclofenac
- Naproxen
NSAIDs with the lowest risk of gastrointestinal toxicities including ulcers and bleeding
- Ibuprofen
Increased Risk of Heart Failure
NSAIDs increase the risk of heart failure. The result of the study published in the British Medical Journal showed that NSAIDs increased the risk of heart failure by 19 per cent. The risk increases with the amount of NSAIDs the person had.
Researchers looked medical history of millions of patients 18 years and over from four European countries (the United Kingdom, Netherlands, Germany and Italy). They looked at the risk of hospital admission for heart failure while currently using 27 different types of NSAIDs and found that current use of any of the NSAIDs was associated with a 19 percent increase of risk of being admitted in hospital for heart failure.
Seven NSAIDs particular led to an increased risk of heart failure.
- Diclofenac,
- Naproxen
- Ibuprofen
- Indomethacin
- Piroxicam
- Ketorolac
- Nimesulide
Renal Failure
While renal failure associated with NSAIDs not common, A study by Delmas (1995) reported that acute renal failure associated with NSAID use accounts for up to 15.6% of cases of all drug-induced renal failure. Another study by Dixit, Mehul et al. in 2010 also concluded that NSAIDs present a significant risk of renal failure for a significant duration. It is recommended that people with chronic kidney disease avoid NSAIDs.
Prostaglandins play so many important roles. Apart from activating inflammation as already discussed, they can induce vasodilatation (widening of blood vessels). This increases renal blood flow (blood flow to the kidneys). As NSAIDs block the production of these prostaglandins as described above, they reduce renal blood flow. This is mainly how NSAIDs cause kidney damage or failure even though they can also directly damage the kidneys.
Effects on airways and Asthma
NSAIDs cab provokes asthma symptoms in some patients who suffer from asthma. The severity of these symptoms can range from mild reactions which may not be noticed or clinically significant to severe and even life-threatening asthma. Patients who have a sensitivity to aspirin or one NSAID are more likely to react to another NSAIDs
However, according to prevalence data, about 80-90% of adult with asthma can tolerate aspirin and other NSAIDs. It is important however that all asthma patients know of the potential risk of taking NSAIDs.
Aspirin and Reyes syndrome
The use of aspirin or other salicylates is associated with an increased risk for developing Reye’s syndrome, especially when used during a viral illness like chickenpox or flu. This syndrome is rare but profoundly serious as it can cause liver and brain damage. It could sometimes lead to fatal liver disease or permanent brain damage. It is recommended that children and teenagers under the age of 16 should not take aspirin or products containing aspirin.
How to safely take NSAIDs
- Take the lowest effective dose for the shortest period of time to control pain.
- Use NSAIDs with a low risk e.g. ibuprofen
- Do not to use more than one oral NSAID at a time.