Aspirin vs. NSAIDs for Pain: Is Aspirin an NSAID?

• Aspirin is a type of nonsteroidal anti-inflammatory drug (NSAID). NSAIDs are non-narcotic pain relievers.
• Aspirin and other NSAIDs are used to treat pain and reduce inflammation from a variety of causes, such as headaches, injuries, arthritis, menstrual cramps, and muscle aches. NSAIDs also are used as fever reducers.
• Aspirin also prevents blood clots (i.e., is antithrombotic).
• Other examples of NSAIDs include ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), diclofenac (Cataflam, Voltaren), indomethacin (Indocin), oxaprozin (Daypro), and piroxicam (Feldene).
• The most common side effects of aspirin and NSAIDs are gastrointestinal (GI), and include:
  • Nausea
  • Vomiting
  • Diarrhea
  • Constipation
  • Abdominal upset or pain
  • Loss of appetite
  • Stomach ulcers
  • Ringing in the ears
• Other side effects of aspirin and NSAIDs include:
  • Skin rash
  • Dizziness
  • Headache
  • Drowsiness
• Serious side effects of aspirin and NSAIDs include:
  • Kidney or liver failure
  • Serious gastrointestinal bleeding
  • Prolonged bleeding after surgery
• Children and teenagers who have or are recovering from chickenpox or the flu should not take aspirin or other NSAIDs because of the risk of developing Reye's Syndrome, a rare and serious illness of the liver and nervous system that can lead to coma and death.

Aspirin is type of nonsteroidal anti-inflammatory drug (NSAID) effective in treating fever, pain, and inflammation in the body. It also prevents blood clots (i.e., is antithrombotic).

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to treat pain and reduce inflammation from a variety of causes, such as headaches, injuries, arthritis, menstrual cramps, and muscle aches. NSAIDs are also used as fever reducers.

NSAIDs work by blocking two forms of an enzyme called cyclooxygenase (COX). COX-1 protects the stomach lining from digestive acids, and helps maintain kidney function. COX-2 is produced when joints are injured or inflamed. Blocking both forms of this enzyme reduces inflammation, pain, and fever, but can also cause gastrointestinal side effects.

Aspirin uses

Aspirin is used for the treatment of inflammation, fever, and pain that results from many forms of arthritis, including:

• Rheumatoid arthritis
• Juvenile rheumatoid arthritis
• Systemic lupus erythematosus
• Ankylosing spondylitis
• Reiter's syndrome
• Osteoarthritis
• Soft tissue injuries, such as tendinitis and bursitis

Aspirin also is used for rapid relief of mild to moderate pain and fever in other inflammatory conditions. Because aspirin inhibits the function of platelets for prolonged periods of time, it is used for reducing the risk of another stroke or heart attack in people who have already had a stroke or heart attack.

NSAID uses

• NSAIDs are used primarily to treat inflammation, mild to moderate pain, and fever.
• Specific uses include the treatment of headaches, arthritis, ankylosing spondylitis, sports injuries, and menstrual cramps.
• Ketorolac (Toradol) is only used for short-term treatment of moderately severe acute pain that otherwise would be treated with narcotics.
• Aspirin (also an NSAID) is used to inhibit the clotting of blood and prevent strokes and heart attacks in individuals at high risk for strokes and heart attacks.
• NSAIDs also are included in many cold and allergy preparations.
• Celecoxib (Celebrex) is used for treating familial adenomatous polyposis (FAP) to prevent the formation and growth of colon polyps.

Side effects of aspirin

Most patients benefit from aspirin and other NSAIDs with few side effects. However, serious side effects can occur and generally tend to be dose-related. Therefore, it is advisable to use the lowest effective dose to minimize side effects.

The most common side effects of aspirin involve the gastrointestinal system and ringing in the ears.

Gastrointestinal (GI) side effects include:

• ulcerations,
• abdominal burning,
• pain,
• cramping,
• nausea,
• gastritis, and
• even serious gastrointestinal bleeding, and
• liver toxicity.

Sometimes, ulceration and bleeding can occur without any abdominal pain. Black tarry stools, weakness, and dizziness upon standing may be the only signs of internal bleeding.

Ringing in the ears

Should ringing in the ears occur, the daily dose should be reduced.

Other side effects of aspirin include:

• Rash
• Kidney impairment
• Vertigo
• Dizziness

Other side effects and adverse reactions of aspirin

• Aspirin should be avoided by patients with peptic ulcer disease or poor kidney function, since this medication can aggravate both conditions.
• Aspirin may exacerbate asthma.
• Aspirin can raise the blood uric acid level and is avoided in patients with hyperuricemia and gout.
• Children and teenagers should avoid aspirin for symptoms of the flu or chickenpox because of the associated risk of Reye's Syndrome, a serious disease of the liver and nervous system that can lead to coma and death.
• Aspirin can increase the effect of medicines used to treat diabetes mellitus, resulting in abnormally low blood sugars if blood sugar levels are not monitored.
• NSAIDs should be discontinued prior to elective surgery because of a mild tendency to interfere with blood clotting. Aspirin, because of its prolonged effect on platelets, is best discontinued at least ten to fourteen days in advance of the procedure.

Side effects of NSAIDs

NSAIDs are associated with several side effects. The frequency of side effects varies among NSAIDs.

Common side effects of NSAIDs are

• nausea,
• vomiting,
• diarrhea,
• constipation,
• decreased appetite,
• rash,
• dizziness,
• headache, and
• drowsiness.

Other important side effects are:

• kidney failure (primarily with chronic use),
• liver failure,
• ulcers, and
• prolonged bleeding after injury or surgery.

NSAIDs can cause fluid retention which can lead to edema, which is most commonly manifested by swelling of the ankles.

WARNING: 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, a serious and sometimes fatal liver disease. 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 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. Therefore, NSAIDs should not be used for the treatment of pain resulting from coronary artery bypass graft (CABG) surgery.

Aspirin drug interactions

Aspirin is associated with several suspected or probable interactions that affect the action of other drugs. The following examples are the most common of the suspected interactions.

NSAIDs may increase the blood levels of lithium (Eskalith, Lithobid) by reducing the excretion of lithium by the kidneys. Increased levels of lithium may lead to lithium toxicity.

Aspirin may reduce the blood pressure lowering effects of blood pressure medications. This may occur because prostaglandins have a role in the regulation of blood pressure.

When aspirin is used in combination with methotrexate (Rheumatrex, Trexall) or aminoglycoside antibiotics (for example, gentamicin) the blood levels of the methotrexate or aminoglycoside may increase, presumably because their elimination from the body is reduced. This may lead to more methotrexate or aminoglycoside-related side effects.

Individuals taking oral blood thinners or anticoagulants, for example, warfarin, (Coumadin) should avoid aspirin because aspirin also thins the blood, and excessive blood thinning may lead to serious bleeding.

NSAID drug interactions

NSAIDs reduce blood flow to the kidneys and therefore reduce the action of diuretics ("water pills") and decrease the elimination of lithium (Eskalith, Lithobid) and methotrexate (Rheumatrex, Trexall). As a result, the blood levels of these drugs may increase as may their side effects.

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.

NSAIDs 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.

NSAIDs increase the negative effect of cyclosporine on kidney function.

Persons who have more than three alcoholic beverages per day may be at increased risk of developing stomach ulcers when taking NSAIDs.

NSAIDs vary in their potency, duration of action, how they are eliminated from the body, how strongly they inhibit COX-1 versus COX-2 and their tendency to cause ulcers and promote bleeding. The more an NSAID blocks COX-1, the greater is its tendency to cause ulcers and promote bleeding. One NSAID, celecoxib (Celebrex), blocks COX-2 but has little effect on COX-1, and is therefore further classified as a selective COX-2 inhibitor. Selective COX-2 inhibitors cause less bleeding and fewer ulcers than other NSAIDs.

Aspirin is a unique NSAID, not only because of its many uses, but because it is the only NSAID that inhibits the clotting of blood for a prolonged period of time (4 to 7 days). This prolonged effect of aspirin makes it an ideal drug for preventing blood clots that cause heart attacks and strokes.

Most NSAIDs inhibit the clotting of blood for only a few hours. Ketorolac (Toradol) is a very potent NSAID and is used for moderately severe acute pain that usually requires narcotics. Ketorolac causes ulcers more frequently than other NSAID. Therefore, it is not used for more than five days. Although NSAIDs have a similar mechanism of action, individuals who do not respond to one NSAID may respond to another.