Some individuals are allergic to NSAIDs and may develop shortness of breath when an NSAID is taken. People with asthma are at a higher risk for experiencing serious allergic reaction to NSAIDs. Individuals with a serious allergy to one NSAID are likely to experience a similar reaction to a different NSAID.

Use of aspirin in children and teenagers with chickenpox or influenza has been associated with the development of Reye's syndrome. Therefore, aspirin and non-aspirin salicylates [for example, salsalate (Amigesic)] should not be used in children and teenagers with suspected or confirmed chickenpox or influenza.

NSAIDs may increase the risk of potentially fatal, stomach and intestinal adverse reactions (for example, bleeding, ulcers, and perforation of the stomach or intestines). These events can occur at any time during treatment and without warning symptoms. Elderly patients are at greater risk for these adverse events. NSAIDs (except low dose aspirin) may increase the risk of potentially fatal heart attacks, stroke, and related conditions. This risk may increase with duration of use and in patients who have underlying risk factors for heart and blood vessel disease. NSAIDs should not be used for the treatment of pain resulting from coronary artery bypass graft (CABG) surgery.

With which drugs do NSAIDs interact?

NSAIDs reduce blood flow to the kidneys and therefore reduce the action of diuretics and decrease the elimination of lithium (Eskalith) and methotrexate (Rheumatrex).

NSAIDs also decrease the ability of the blood to clot and therefore increase bleeding. When used with other drugs that also increase bleeding [for example, warfarin (Coumadin)], there is an increased likelihood of serious bleeding or complications of bleeding. Therefore, individuals who are taking drugs that reduce the ability of blood to clot should avoid prolonged use of NSAIDs.

Nonsteroidal antiinflammatory drugs also may increase blood pressure in patients with hypertension (high blood pressure) and therefore antagonize the action of drugs that are used to treat hypertension.

What NSAIDS are approved in the United States?

The complete list of approved NSAIDs is very long. The following list contains only NSAIDs that are commonly used:

• aspirin
• celecoxib (Celebrex)
• diclofenac (Voltaren)
• diflunisal (Dolobid)
• etodolac (Lodine)
• ibuprofen (Motrin)
• indomethacin (Indocin)
• ketoprofen (Orudis)
• ketorolac (Toradol)
• nabumetone (Relafen)
• naproxen (Aleve, Naprosyn)
• oxaprozin (Daypro)
• piroxicam (Feldene)
• salsalate (Amigesic)
• sulindac (Clinoril)
• tolmetin (Tolectin)

Reference: FDA Prescribing Information