What are nonsteroidal anti-inflammatory drugs (NSAIDs)?

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed medications for the inflammation of arthritis and other body tissues, such as in tendinitis and bursitis. They also are used for minor aches and pains.
Examples of NSAIDs include:
- aspirin,
- indomethacin (Indocin),
- ibuprofen (Motrin),
- naproxen (Naprosyn),
- piroxicam (Feldene),
- nabumetone (Relafen), and
- Celecoxib (Celebrex).
NSAIDs are available by prescription or without a prescription (over-the-counter). They also are ingredients in many over the counter medications used for colds and minor aches and pain. They are administered orally as capsules, tablets, liquids, or by injection (ketorolac, Toradol). Although not included in this review, NSAIDs also are used as eye drops for eye inflammation (for example, ketorolac tromethamine [Acular]).
NSAIDs are taken regularly by approximately 33 million Americans and over 30 billion doses of NSAIDs are consumed annually in the United States.
What are the side effects of NSAIDs?
The major side effects of NSAIDs are related to their effects on the stomach and bowels (gastrointestinal system). Some 10% to 50% of patients are unable to tolerate treatment with NSAIDs because of side effects, including abdominal pain, diarrhea, and upset stomach. Approximately 15% of patients on long-term treatment with NSAIDs develop a peptic ulcer (ulceration of the stomach or duodenum). Even though many of these patients with ulcers do not have symptoms and are unaware of their ulcers, they are at risk of developing serious ulcer complications, such as bleeding or perforation of the stomach.
The annual risk of serious complications is 1% to 4% with chronic treatment with NSAIDs. The risk of ulcers is higher in the elderly and individuals with rheumatoid arthritis, and those also taking steroid-containing medications (for example, prednisone), and individuals with a prior history of bleeding ulcers. Taking blood thinning medications (anticoagulants), such as warfarin (Coumadin), and heparin, does not cause NSAID-related ulcers, but rather they increase bleeding if NSAID-induced ulcers occur.
A prior history of ulcers is the most important predictor of NSAID-induced ulcers. Patients with heart disease who are taking aspirin for prevention of heart attacks also are at risk, and the risk of bleeding ulcers doubles if aspirin is combined with other NSAIDs.

QUESTION
Bowel regularity means a bowel movement every day. See AnswerHow do NSAIDs work, and how do they cause stomach problems?
Prostaglandins are natural chemicals that serve as messengers to promote inflammation. By inhibiting the body's production of prostaglandins, NSAIDs decrease inflammation and the symptoms and signs of inflammation, such as pain, tenderness, and fever. However, certain prostaglandins also are important in protecting the stomach lining from the corrosive effects of stomach acid, as well as playing a role in maintaining the natural, healthy condition of the stomach lining. These protective prostaglandins are produced by an enzyme called Cox-1. By blocking the Cox-1 enzyme and disrupting the production of prostaglandins in the stomach, NSAIDs can cause ulcers and bleeding. Some NSAIDs have less effect on prostaglandins in the stomach than others, and, therefore, may have a lower risk of causing ulcers, but the increased risk of ulcers still exists.
What are treatments for a stomach ulcer?
Treatment of NSAID-induced ulcers involves discontinuing the NSAID, reducing stomach acid with H2-blockers, for example, cimetidine (Tagamet), famotidine (Pepcid), and nizatidine (Axid), or, more effectively, with proton pump inhibitors, such as omeprazole (Prilosec) or synthetic prostaglandins, specifically misoprostol (Cytotec). Since H. pylori bacteria is a common cause of ulcers, eradication of the bacteria with a combination of antibiotics also may promote ulcer healing.
Health News
- What Is Avascular Necrosis and How Does It Affect Bones?
- The Arch of the Human Foot Was Key to Upright Walking, Scientists Say
- Worried About Cataracts? Here's What You Need to Know
- FDA Issues Warning About Compounded Versions of Wegovy, Ozempic
- Sick Restaurant Workers Fuel Many Foodborne Illness Outbreaks
More Health News »
Is it possible to prevent NSAID-related ulcers and complications?
NSAIDs are valuable medications for patients with arthritis and other inflammatory conditions. For patients who need long-term NSAID treatment, several steps can be taken to decrease NSAID-related ulcers and complications. The risk of ulcers and complications tends to be dose related. Therefore, the smallest effective dose of NSAIDs is taken to minimize the risk. NSAIDs might be selected that have less effect on the stomach's production of prostaglandins. Some of these NSAIDs are called selective Cox-2 inhibitors. Cox-2 inhibitors block the Cox-2 enzyme that produces prostaglandins of inflammation without blocking the prostaglandin production of Cox-1 in the stomach. Currently in the United States, the only available selective Cox-2 inhibitor is celecoxib (Celebrex).
Taking NSAIDs with meals may minimize stomach upset with NSAIDs, but not ulcerations.
A synthetic prostaglandin, misoprostol (Cytotec), can be administered orally along with NSAIDs. Misoprostol has been shown to decrease NSAID-induced ulcers and their complications. The side effects of misoprostol include abdominal cramps and diarrhea. Misoprostol also is avoided in pregnant women because it can cause uterine muscle contractions and miscarriage. Standard doses of H2-blockers and proton pump inhibitors reduce the risk of NSAID-induced ulcers.
Scientists are actively searching for safer NSAIDs that are effective anti-inflammatory agents but are not ulcer producing. In the meantime, patients who need long term NSAID treatment should be closely supervised by a doctor. Patients at risk of NSAID-induced ulcers and complications should consider preventive measures, such as using NSAIDs with less prostaglandin disrupting effects on the stomach and using proton pump inhibitors, H2-blockers, or misoprostol. Stopping smoking, and eradicating H. pylori also may be helpful since both smoking and infection with H. pylori themselves cause ulcers.
Health Solutions From Our Sponsors
REFERENCE:
Chan F. Primer. Managing NSAID-induced ulcer complications-balancing gastrointestinal and cardiovascular risk. Nature Clinical Practice Gastroenterology & Hepatology (2006) 3, 563-573.
Top Nonsteroidal Anti-inflammatory Drugs and Ulcers Related Articles
Blood in the Stool (Rectal Bleeding, Hematochezia)
Blood in the stool or rectal bleeding (hematochezia) refers to the passage of bright red blood from the anus. Common causes include anal fissures, hemorrhoids, diverticulitis, colitis, Crohn's disease, colon and rectum polyps, and cancer. The color of the blood in the stool may provide information about the origin of the bleeding. The color of stool with blood in it may range from black, red, maroon, green yellow, gray, or white, and may be tarry, or sticky. Treatment of blood in the stool depends on the cause.Endoscopy (EGD) Procedure
Endoscopy is a broad term used to described examining the inside of the body using an lighted, flexible instrument called an endoscope. Endoscopy procedure is performed on a patient to examine the esophagus, stomach, and duodenum; and look for causes of symptoms such as abdominal pain, nausea, vomiting, difficulty swallowing, or intestinal bleeding.
Fecal Occult Blood Test
A fecal occult blood test (FOBT) is performed on samples of stool in order to detect occult blood in otherwise normal–colored stool. There are two types of fecal occult blood tests: chemical and immunologic. FOBT is primarily used to detect colon cancer. The test can also help discover colon polyps, some of which are a precursor of colon cancer.Hip Bursitis
Bursitis of the hip results when the fluid-filled sac (bursa) near the hip becomes inflamed due to localized soft tissue trauma or strain. Symptoms include stiffness and pain around the hip joint. If the hip bursa is not infected, hip bursitis can be treated with ice compresses, rest, and anti-inflammatory and pain medications.How Do They Fix a Perforated Duodenal Ulcer?
Omental patching is a surgical procedure for treating perforated ulcers. It is also called a Graham patch. This procedure uses a patch of the omentum to repair the injury. A laparoscopic omental patch closure of the perforated duodenal ulcer has become increasingly common. Complications include paralytic Ileus (paralysis of the small intestine), bleeding, infection, abscess (pus) formation, gastric outlet obstruction, necrosis (tissue death), and post-operative leak.Internal Bleeding
Internal bleeding is a serious consequence of trauma and can be life-threatening, requiring immediate medical attention. Learn about signs, causes, and treatment.Peptic Ulcer (Stomach Ulcer)
Peptic or stomach ulcers are ulcers in the lining of the stomach, duodenum, or esophagus. Learn about symptoms, causes, diet, and treatment.Peptic Ulcer Picture
A hole in the lining of the stomach, duodenum, or esophagus. See a picture of Peptic Ulcer and learn more about the health topic.25 Ways to Relieve Menstrual Cramps
Menstrual cramps happen when prostaglandins force the uterus to contract. Dysmenorrhea, or period pain, may be relieved by heating pads, ibuprofen, and other measures. Endometriosis may cause severe cramps during the menstrual cycle. Luckily, women have many options for period pain relief.What Is Spinal Stenosis? Causes of Lumbar & Cervical Spine Stenosis
Spinal stenosis causes back pain, leg pain, difficulty walking and clumsiness. Learn the symptoms of lumbar spinal stenosis and cervical spinal stenosis and what surgeries are used for spinal stenosis treatment. Discover tips for relieving spinal stenosis pain without surgery, as well as useful medications.Stool Color, Changes, Texture and Form
Stool color changes can very from green, red, maroon, yellow, white, or black. Causes of changes of stool color can range from foods a person eats, medication, diseases or conditions, pregnancy, cancer, or tumors. Stool can also have texture changes such as greasy or floating stools. Stool that has a uncharacteristically foul odor may be caused by infections such as giardiasis or medical conditions.Symptoms of 12 Serious Diseases and Health Problems
Learn how to recognize early warning signs and symptoms of serious diseases and health problems, for example, chronic cough, headache, chest pain, nausea, stool color or consistency changes, heartburn, skin moles, anxiety, nightmares, suicidal thoughts, hallucinations, delusions, lightheadedness, night sweats, eye problems, confusion, depression, severe pelvic or abdominal pain, unusual vaginal discharge, and nipple changes.The symptoms and signs of serious health problems can be caused by strokes, heart attacks, cancers, reproductive problems in females (for example, cancers, fibroids, endometriosis, ovarian cysts, and sexually transmitted diseases or STDs), breast problems (for example, breast cancer and non-cancer related diseases), lung diseases (for example, chronic obstructive pulmonary disease or COPD, lung cancer, emphysema, and asthma), stomach or digestive diseases (for example, cancers, gallbladder, liver, and pancreatic diseases, ulcerative colitis, or Crohn's disease), bladder problems (for example, urinary incontinence, and kidney infections), skin cancer, muscle and joint problems, emotional problems or mental illness (for example, postpartum depression, major depression, post-traumatic stress disorder (PTSD), mania, and schizophrenia), and headache disorders (for example, migraines, or "the worst headache of your life), and eating disorders and weight problems (for example, anorexia or bulimia).
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.