- Side Effects
- Drug Interactions
Corticosteroids vs. NSAIDs differences
- Corticosteroids are a type of hormone, and NSAIDs (nonsteroidal anti-inflammatories) are non-narcotic pain relievers. Both medications are prescribed to reduce inflammation in the body.
- NSAIDs are also used to treat pain and reduce fever.
- Common corticosteroids include prednisone, cortisone, and methylprednisolone.
- Examples of NSAIDs include ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), diclofenac (Cataflam, Voltaren), indomethacin (Indocin), oxaprozin (Daypro), and piroxicam (Feldene).
- Side effects of corticosteroids include:
- Side effects of NSAIDs include:
What are corticosteroids and NSAIDs? What are they used for?
Corticosteroids are steroid hormones classified as glucocorticoids (anti-inflammatory), which suppress inflammation and immunity and assist in the breakdown of fats, carbohydrates, and proteins. They may also be classified as mineralocorticoids (salt retaining) that regulate the balance of salt and water in the body. Corticosteroids are used to treat conditions such as arthritis, colitis, asthma, bronchitis, allergic reactions, and skin rashes.
NSAIDs (nonsteroidal anti-inflammatory drugs) 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.
What are the side effect of corticosteroids and NSAIDs?
Corticosteroid side effects
Corticosteroids have many side effects that can be mild or serious. These side effects are more apparent when corticosteroids are used at higher doses or for extended periods of time. This section lists only some of these side effects of corticosteroids.
Corticosteroids can cause:
- Sodium (salt) and fluid to be retained in the body and cause weight gain or swelling of the legs (edema)
- High blood pressure
- Loss of potassium
- Muscle weakness
- Puffiness of the face (moon face)
- Facial hair growth
- Thinning and easy bruising of the skin
- Slow wound healing
- Ulcers in the stomach and duodenum
- Loss of diabetes control
- Menstrual irregularity
- "Buffalo hump," a condition described as a rounding of the upper back
The prolonged use of corticosteroids can cause obesity, growth retardation in children, and even lead to convulsions and psychiatric disturbances. Reported psychiatric disturbances include depression, euphoria, insomnia, mood swings, and personality changes. Psychotic behaviors also have been reported.
Corticosteroids, since they suppress the immune system, can lead to an increase in the rate of infections and reduce the effectiveness of vaccines and antibiotics.
The long term use of corticosteroids may cause osteoporosis which can result in bone fractures.
Shrinking (atrophy) of the adrenal glands can be caused by the long term use of corticosteroids resulting in the body's inability to produce cortisol, the body's natural corticosteroid, when the systemic corticosteroids are discontinued.
Another condition which can result from the long term use of corticosteroids is adrenal necrosis of the hip joints, a very painful and serious condition that may require surgery. Any symptoms of hip or knee pain in people taking corticosteroids require prompt medical attention.
Corticosteroids should not be stopped suddenly after prolonged use as this can result in adrenal crisis because of the body's inability to secrete enough cortisol to make up for the withdrawal. Nausea, vomiting, and shock are the reported side effects of adrenal crisis.
NSAID side effects
NSAIDs are associated with several side effects. The frequency of side effects varies among NSAIDs.
Common side effects are
- decreased appetite,
- headache, and
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.
Which drugs interact with corticosteroids and NSAIDs?
Corticosteroid drug interactions
- Certain drugs such as troleandomycin (TAO), erythromycin (Ery-Tab, EryPed 200), and clarithromycin (Biaxin) and ketoconazole (Nizoral) can reduce the ability of the liver to metabolize (breakdown) corticosteroids and this may lead to an increase in the levels and side effects of corticosteroids in the body. On the other hand, phenobarbital, ephedrine, phenytoin (Dilantin), and rifampin (Rifadin, Rimactane) may reduce the blood levels of corticosteroids by increasing the breakdown of corticosteroids by the liver.
- This may necessitate an increase of corticosteroid dose when they are used in combination with these drugs.
- Estrogens have been shown to increase the effects of corticosteroids possibly by decreasing their breakdown by the liver.
- Corticosteroid effects on warfarin can vary; therefore when taking warfarin (Coumadin) along with corticosteroids, there may be increased need for monitoring coagulation levels more closely.
- Low blood potassium (hypokalemia) and a higher chance of heart failure can result from combining corticosteroids with drugs that reduce potassium in the blood (for example, diuretics, amphotericin B).
- Anticholinesterase drugs (for example, physostigmine) may cause severe weakness in some patients with myasthenia gravis when prescribed with corticosteroids. Corticosteroids can increase blood glucose, so close monitoring of blood sugar and higher doses of diabetes medications may be needed.
NSAID drug interactionss
- 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.
- People who have more than three alcoholic beverages per day may be at increased risk of developing stomach ulcers when taking NSAIDs.
What are the different types of corticosteroids and NSAIDs?
The following is a list of the systemic (oral and injectable) corticosteroids that are available in the United States:
- hydrocortisone (Cortef)
- ethamethasoneb (Celestone)
- prednisone (Prednisone Intensol)
- prednisolone (Orapred, Prelone)
- triamcinolone (Aristospan Intra-Articular, Aristospan Intralesional, Kenalog) Methylprednisolone (Medrol, Depo-Medrol, Solu-Medrol)
- dexamethasone (Dexamethasone Intensol, DexPak 10 Day, DexPak 13 Day, DexPak 6 Day)
The following list is an example of NSAIDs available:
- celecoxib (Celebrex)
- diclofenac (Cambia, Cataflam, Voltaren-XR, Zipsor, Zorvolex)
- diflunisal (Dolobid - discontinued brand)
- etodolac (Lodine - discontinued brand)
- ibuprofen (Motrin, Advil)
- indomethacin (Indocin)
- ketoprofen (Active-Ketoprofen [Orudis - discontinued brand])
- ketorolac (Toradol - discontinued brand)
- nabumetone (Relafen - discontinued brand)
- naproxen (Aleve, Anaprox, Naprelan, Naprosyn)
- oxaprozin (Daypro)
- piroxicam (Feldene)
- salsalate (Disalsate [Amigesic - discontinued brand])
- sulindac (Clinoril - discontinued brand)
- tolmetin (Tolectin - discontinued brand)
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Corticosteroids are synthetic hormones, and NSAIDs (nonsteroidal anti-inflammatory drugs) are non-narcotic pain relievers. Both medications reduce inflammation. NSAIDs are also used to treat pain and reduce fever.
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- Brain Cancer Symptoms: Headaches and Seizures
- The Worst Headache of Your Life: Brain Hemorrhage Symptoms
- Pain Management: OTC NSAIDs - Doctors Dialogue
- Pain Management Over-The-Counter
- What Not to Eat When You Have Arthritis
- How Do Arthritis Symptoms Start?
- Ultrasound Imaging of Joints in Rheumatoid Arthritis (RA)
- Doctors Answer Pain Questions
- What Are the Side Effects of Glucosamine?
- Can Headaches Be a Sign of Throat Cancer?
- How to Treat Rebound Headaches
- Can Alcohol Injections in the Eye Nerves Stop Headaches?
- What's the Rheumatoid Arthritis Prognosis?
- Patient Story: Rheumatoid Arthritis Treatment
- Pain Relievers and High Blood Pressure
- Headaches from Food: The Connection
Medications & Supplements
- Nonsteroidal Anti-inflammatory Drugs (NSAIDs)
- aspirin - oral, Easprin, Ecotrin
- naproxen - oral, Anaprox, Naprosyn
- ibuprofen - oral, Advil, Motrin, Nuprin
- Antihistamines vs. Corticosteroids
- Lyrica vs. Gabapentin
- Ketorolac vs. diclofenac
- Ketorolac vs. ketoprofen
- dexamethasone (Decadron, DexPak)
- hydrocortisone injection (Solu-Cortef, A-Hydrocort)
- erenumab (Aimovig)
- PPIs vs. NSAIDs
- Can Botulinum Toxin Be Used for Pain Relief?
- Types of Migraine Headache Medications
Prevention & Wellness
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
Top Corticosteroids vs NSAIDs Related Articles
Fever in Adults and ChildrenAlthough a fever technically is any body temperature above the normal of 98.6 F (37 C), in practice, a person is usually not considered to have a significant fever until the temperature is above 100.4 F (38 C). Fever is part of the body's own disease-fighting arsenal; rising body temperatures apparently are capable of killing off many disease-producing organisms.
Allergy (Allergies)An allergy refers to a misguided reaction by our immune system in response to bodily contact with certain foreign substances. When these allergens come in contact with the body, it causes the immune system to develop an allergic reaction in people who are allergic to it. It is estimated that 50 million North Americans are affected by allergic conditions. The parts of the body that are prone to react to allergies include the eyes, nose, lungs, skin, and stomach. Common allergic disorders include hay fever, asthma, allergic eyes, allergic eczema, hives, and allergic shock.
Ankylosing Spondylitis: Symptoms, Diagnosis, and TreatmentWhat is ankylosing spondylitis (AS)? Ankylosing spondylitis is arthritis of the spine. Learn diet and exercise tips for AS, and how to improve posture. See the diagnosis steps for AS, and find helpful treatments that relieve pain and stiffness.
Arthritis (Joint Inflammation)Arthritis is inflammation of one or more joints. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of arthritis, including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, gout, and pseudogout.
Acute BronchitisBronchitis is inflammation of the airways in the lung. Acute bronchitis is short in duration (10-20 days) in comparison with chronic bronchitis, which lasts for months to years. Causes of acute bronchitis include viruses and bacteria, which means it can be contagious. Acute bronchitis caused by environmental factors such as pollution or cigarette smoke is not contagious. Common symptoms for acute bronchitis include nasal congestion, cough, headache, sore throat, muscle aches, and fatigue. Acute bronchitis in children also my include runny nose, fever, and chest pain. Treatment for acute bronchitis are OTC pain relievers, cough suppressants (although not recommended in children), and rest. Infrequently antibiotics may be prescribed to treat acute bronchitis.
Cold, Fever and Flu Symptoms in Children: Medications and Home RemediesHow long does a cold last? How long is a cold contagious? Colds and fevers are some of the most common ailments in children. Learn common cold symptoms, treatment options, over the counter (OTC) medicines for cold and fever, home remedies, and how to relieve a sore throat.
ColitisColitis refers to inflammation of the inner lining of the colon. Symptoms of the inflammation of the colon lining include diarrhea, pain, and blood in the stool. There are several causes of colitis, including infection, ischemia of the colon, inflammatory bowel disease (Crohn's disease, ulcerative colitis, infectious colitis like C. difficile, or microscopic colitis). Treatment depends on the cause of the colitis.
Headaches can be divided into two categories: primary headaches and secondary headaches. Migraine headaches, tension headaches, and cluster headaches are considered primary headaches. Secondary headaches are caused by disease. Headache symptoms vary with the headache type. Over-the-counter pain relievers provide short-term relief for most headaches.
What Is the Life Expectancy of Someone with Crohn's Disease?Crohn’s disease is a chronic condition that causes inflammation in the gut (digestive tract).Crohn’s disease belongs to a group of conditions known as inflammatory bowel disease (IBD). With appropriate management, patients with Crohn’s disease may expect a normal life expectancy and a good quality of life.
Osteoarthritis SlideshowOsteoarthritis (OA) is a degenerative joint disease most often affecting major joints such as knees, hands, back, or hips. Osteoarthritis symptoms include pain, swelling and joint inflammation.
Pain ManagementPain management and treatment can be simple or complex, according to its cause. There are two basic types of pain, nociceptive pain and neuropathic pain. Some causes of neuropathic pain include:
- complex regional pain syndrome,
- interstitial cystitis,
- and irritable bowel syndrome.
Pain QuizIs pain all in the brain? Take the Pain Quiz to learn everything you've ever wanted to know about the unpleasant sensation we call pain.
RA QuizHow is rheumatoid arthritis different from other forms of arthritis, such as osteoarthritis and gout? Take the Rheumatoid Arthritis (RA) Quiz to rest your RA IQ.
What Is a Digital Flexor Injection?A digital flexor injection is a conservative treatment for a trigger finger typically given under local anesthesia. In this treatment, the affected area is injected with a corticosteroid. This treatment may provide temporary but rapid relief from the pain and triggering. This injection can permanently improve the trigger finger, but in some cases, the problem can return after treatment.
What Is the Safest Anti-Inflammatory to Take?Non-steroidal anti-inflammatory drugs or NSAIDs are some of the most commonly used medicines available. Experts say that taking NSAIDs for a short time at the lowest effective dose is generally safe.