- A Visual Guide to Migraine Headaches Slideshow
- Headache and Migraine Triggers Slideshow
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What are NSAIDs and how do they work?
Prostaglandins are a family of chemicals that are produced by the cells of the body and have several important functions. They promote inflammation that is necessary for healing, but also results in pain, and fever; support the blood clotting function of platelets; and protect the lining of the stomach from the damaging effects of acid.
Prostaglandins are produced within the body's cells by the enzyme cyclooxygenase (COX). There are two COX enzymes, COX-1 and COX-2. Both enzymes produce prostaglandins that promote inflammation, pain, and fever. However, only COX-1 produces prostaglandins that support platelets and protect the stomach. Nonsteroidal anti-inflammatory drugs (NSAIDs) block the COX enzymes and reduce prostaglandins throughout the body. As a consequence, ongoing inflammation, pain, and fever are reduced. Since the prostaglandins that protect the stomach and support platelets and blood clotting also are reduced, NSAIDs can cause ulcers in the stomach and promote bleeding.
What NSAIDs are approved in the United States?
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)
Quick GuideMigraine or Headache? Migraine Symptoms, Triggers, Treatment
What are the side effects of NSAIDs?
NSAIDs are associated with several side effects. The frequency of side effects varies among NSAIDs.
Common side effects are
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.
For what conditions are NSAIDs used?
NSAIDs are used primarily to treat inflammation, mild to moderate pain, and fever.
Specific uses include the treatment of:
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.
Are there any differences between 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.
With which drugs do NSAIDs interact?
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 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.
Nonsteroidal antiinflammatory drugs (NSAIDs) are a class of drugs are used to treat inflammation, mild to moderate pain, and fever. Examples of the most common NSAIDs include: aspirin salsalate (Amigesic), diflunisal (Dolobid), ibuprofen (Motrin), ketoprofen (Orudis), nabumetone (Relafen), piroxicam (Feldene), naproxen (Aleve, Naprosyn,) diclofenac (Voltaren), indomethacin (Indocin), sulindac (Clinoril), tolmetin (Tolectin), etodolac (Lodine), ketorolac (Toradol), oxaprozin (Daypro), celecoxib (Celebrex).
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Treatment & Diagnosis
- Leg Pain
- Finger Pain
- Buttock Pain
- Hand Pain
- Joint Pain
- Wrist Pain
- Shoulder Pain
- Sore Tongue
- Stiff Neck
- Lower Back Pain
- Knee Pain
- Joint Stiffness
- West Nile Virus
- Swollen Joints
- Neck Pain (Cervicalgia)
- Joint Redness
- Joint Warmth
- Chronic Sore Throat
- PMS (Premenstrual Syndrome)
- Pleurisy (Pleuritis)
- Dry Socket
- Common Cold
- Doctor: Checklist to Take To Your Doctor's Appointment
- Gum Disease
- Abscessed Tooth
- Headaches FAQs
- Back Pain FAQs
- Pain FAQs
- Ankylosing Spondylitis FAQs
- Celebrex - New Arthritis Drug
- Pain Management Over-The-Counter
- Pharmacy Visit, How To Get The Most Out of Your Visit
- Indications for Drugs: Approved vs. Non-approved
- How To Reduce Your Medication Costs
- Cox-2 Inhibitors Dilemma: What Patients Should Do
- The Cox-2 Inhibitors Controversy: Q&A with Dr. Shiel
- Pain (Acute and Chronic)
- Drugs: Buying Prescription Drugs Online Safely
- Medication Disposal
- Dangers of Mixing Medications
- Drugs: The Most Common Medication Errors
- Do NSAIDs Interact With Coumadin?
- Generic Drugs, Are They as Good as Brand-Names?
Medications & Supplements
- naproxen (Aleve, Anaprox, Naprelan, Naprosyn)
- Oxycodone vs. Tramadol for Pain
- Ibuprofen vs. Meloxicam (Mobic) for Pain
- ibuprofen (Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever, and others)
- indomethacin, Indocin, Indocin-SR (Discontinued Brand in U.S.)
- celecoxib (Celebrex)
- aspirin (acetylsalicylic acid, Bayer, Ecotrin, and others)
- Drugs: Questions to Ask Your Doctor or Pharmacist about Your Drugs
- Cox-2 Inhibitors
- Drug Interactions
- Aspirin vs. Plavix (clopidogrel)
- nabumetone, Relafen (Discontinued)
- piroxicam, Feldene
- erenumab (Aimovig)
- diclofenac, Voltaren, Cataflam, Voltaren-XR, Cambia
- ketorolac (Toradol brand has been discontinued in the US)
- flurbiprofen (Ansaid is a discontinued brand)
- Tramadol (Ultram) Side Effects
- Ibuprofen and Plavix (Side Effects and Interactions)
- fenoprofen, Nalfon
- Aspirin vs. NSAIDs (Side Effect and Use Differences)
- etodolac, Lodine (Discontinued)
- phenylbutazone, Butazolidine
- oxaprozin, Daypro
- Aspirin Therapy (Guidelines for Heart Attack and Stroke Prevention)
- ketoprofen (Discontinued brands: Nexcede, Orudis, Oruvail, Actron)
- sulindac, Clinoril
- diflunisal, Dolobid
- OTC Pain Relievers and Fever Reducers
- tolmetin, Tolectin (Discontinued Brand)
- salsalate, Amigesic, Salflex, Argesic-SA, Marthritic, Salsitab, Artha-G
- valdecoxib, Bextra
- meclofenamate; Meclomen
- choline magnesium salicylate, Trilisate
Prevention & Wellness
- Living with Chronic Pain
- Swine Flu: Taking Care of a Sick Person in Your Home
- 12 Tips for Family Emergencies
- Drug Name Confusion: Preventing Medication Errors
- Cox-2 Inhibitors: FDA Announces Series of Changes to the Class of Marketed Non-Steroidal
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- Vioxx: FDA Statement on Recent Allegations
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- Pain Relievers Use Caution
- Prescriptions - Talk About Them
Migraines and Headaches Resources
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.
Reference: FDA Prescribing Information.
Top Nonsteroidal Antiinflammatory Drugs Related Articles
Back Pain QuizThere are numerous causes of chronic lower back pain and only one ailment gets more complaints. What is it? Quiz your knowledge of symptoms, treatments, problems, and reasons for common back pain.
Chronic Pain SyndromeWhat is chronic pain syndrome (CPS)? See causes, symptoms and treatment options including medications. Learn about pain management tips such as strength training, biofeedback, and yoga, as well as forms of chronic pain such as lower back pain, arthritis, migraines, and more.
Common Medical Abbreviations and Terms
Doctors, pharmacists, and other health-care professionals use abbreviations, acronyms, and other terminology for instructions and information in regard to a patient's health condition, prescription drugs they are to take, or medical procedures that have been ordered. There is no approved this list of common medical abbreviations, acronyms, and terminology used by doctors and other health- care professionals. You can use this list of medical abbreviations and acronyms written by our doctors the next time you can't understand what is on your prescription package, blood test results, or medical procedure orders. Examples include:
- ANED: Alive no evidence of disease. The patient arrived in the ER alive with no evidence of disease.
- ARF: Acute renal (kidney) failure
- cap: Capsule.
- CPAP: Continuous positive airway pressure. A treatment for sleep apnea.
- DJD: Degenerative joint disease. Another term for osteoarthritis.
- DM: Diabetes mellitus. Type 1 and type 2 diabetes
- HA: Headache
- IBD: Inflammatory bowel disease. A name for two disorders of the gastrointestinal (BI) tract, Crohn's disease and ulcerative colitis
- JT: Joint
- N/V: Nausea or vomiting.
- p.o.: By mouth. From the Latin terminology per os.
- q.i.d.: Four times daily. As in taking a medicine four times daily.
- RA: Rheumatoid arthritis
- SOB: Shortness of breath.
- T: Temperature. Temperature is recorded as part of the physical examination. It is one of the "vital signs."
Dry Socket OverviewA dry socket is a potential complication that can occur when a blood clot in the gums becomes dislodged after a tooth extraction. Dry socket signs and symptoms include pain, mouth odor, and unpleasant taste in the mouth. A dentist may treat a dry socket with analgesic dressing. Over-the-counter pain medications can also relieve symptoms. A dry socket usually heals within 7 days. Avoiding smoking, drinking with a straw, and vigorous rinsing and spitting may help prevent the formation of dry socket.
Endometriosis implants are most commonly found on the ovaries, the Fallopian tubes, outer surfaces of the uterus or intestines, and on the surface lining of the pelvic cavity. They also can be found in the vagina, cervix, and bladder. Endometriosis may not produce any symptoms, but when it does the most common symptom is pelvic pain that worsens just prior to menstruation and improves at the end of the menstrual period. Other symptoms of endometriosis include pain during sex, pain with pelvic examinations, cramping or pain during bowel movements or urination, and infertility.
Treatment of endometriosis can be with medication or surgery.
Gout PictureCondition characterized by abnormally elevated levels of uric acid in the blood, recurring attacks of joint inflammation (arthritis), deposits of hard lumps of uric acid in and around the joints, and decreased kidney function and kidney stones. See a picture of Gout and learn more about the health topic.
Gout SlideshowGout attacks (gouty arthritis) are caused by crystals of uric acid deposits. Learn about symptoms, causes, treatments and medication for this painful condition.
HeadacheHeadaches 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.
Headaches QuizIf you're plagued with headaches, our Headaches Quiz may help you identify causes, triggers, symptoms, and treatments for headache pain caused by different types of headaches such as migraines, sinus, cluster, tension, or stress.
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- abnormal vaginal bleeding,
- congenital abnormalities of the female genital tract,
- scarring from previous procedures,
- and removal of uterine fibroids or tumors.
MenstruationMenstruation (menstrual cycle) is also referred to as a "period." When a woman menstruates, the lining of the uterus is shed. This shedding of the uterine linking is the menstrual blood flow. The average menstrual cycle is 28 days. There can be problems with a woman's period, including heavy bleeding, pain, or skipped periods. Causes of these problems may be amenorrhea (lack fo a period), menstrual cramps (dysmenorrhea), or abnormal vaginal or uterine bleeding. There are a variety of situations in which a girl or woman should see a doctor about her menstrual cycle.
Nerve Pain SlideshowLearn about nerve pain symptoms, causes, and treatment options. Discover medications, treatments, and natural remedies that can offer relief for dealing with the symptoms caused by nerve pain.
Take the 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.
Sciatica SlideshowSciatica pain radiates from the lower back toward the feet. Sciatica may feel like a cramp in the leg, burning, tingling, pins and needles, or numbness. Learn about sciatica causes, exercises, treatment and pain relief.
Sore Throat Home Remedies and Treatment
Natural and home remedies for sore throat symptoms and pain relief include essential oils, licorice gargles, slippery elm leaves, raw garlic, Throat Coat tea, sage, and acupuncture. Typical symptoms of a sore throat include throat pain, coughing, sneezing, fever, and swollen lymph nodes. Sore throats are caused by viral (common cold, flu, mumps), bacterial (tonsillitis, some STDs), toxins, allergens, trauma or injury, or "mechanical causes" (breathing through the mouth).
TonsillectomyTonsillectomy is the surgical removal of both tonsils. A tonsillectomy may be performed in cases of recurrent tonsillitis, or treat sleep apnea and some speech disorders.
Urea Breath TestThe urea breath test (UBT) is a test used to diagnose the presence of Helicobacter pylori (H. pylori) bacteria in the stomach. H. pylori causes, ulcers, inflammation, and atrophy of the stomach. The urea breath test is fairly simple, with few side effects, risks, or complications.