What are nonsteroidal anti-inflammatory medications (NSAIDs)?
NSAIDs are medicines that can reduce pain, fever, and inflammation. Inflammation is the body¡¯s protective response to irritation or injury and is characterized by redness, warmth, swelling and pain. NSAIDs can be used to treat the symptoms of various types of arthritis and soft tissue inflammation such as tendonitis, bursitis and sprains. It can also be used for gout attacks.

It is important to remember that NSAIDs treat the symptoms and do not cure arthritis. This medicine only works as long as you are taking it. There are lower doses of NSAIDs available over the counter but most drugs in this class require a doctor¡¯s prescription.

How do NSAIDs work?
NSAIDs block the production of certain body chemicals called prostaglandins that are involved in inflammation and pain. More specifically, NSAIDs work by blocking an enzyme called cyclooxygenase (COX).

Are all NSAIDs the same?
There appears to be no fundamental difference in the ability of different NSAIDs to reduce pain and inflammation. However, some NSAIDs may be safer than others. Each patient may respond differently to each class of NSAIDs. Some NSAIDs may be more convenient for patients, since they need only be taken once or twice a day. Generic drugs are also less expensive than brand name drugs.

How are NSAIDs prescribed?
When you are prescribed a particular NSAID, your health care provider balances the risks and benefits of your medical condition, safety, convenience and cost. NSAIDs are prescribed in different doses, depending on your condition. Your health care provider may prescribe higher doses of NSAIDs if you have rheumatoid arthritis, for example, because there is frequently a significant degree of swelling, redness and stiffness in the joints. Lower doses may be adequate for osteoarthritis affecting one joint or acute muscle injuries, since there is generally less swelling and frequently no warmth or redness to the joints.

No single NSAID is guaranteed to work. Your health care provider may prescribe several types of NSAIDs to find the one that works best for you.

The dose of these drugs will be different for different patients depending on your diagnosis and associated medical problems. Follow your doctor's orders or the directions on the label. If you are having more pain or a flare up, do not increase your dose of NSAIDs without talking to your doctor. Higher than recommended doses of NSAIDs or taking more than one type of NSAID at one time can increase your chances of having side effects.

What are some common side effects of NSAIDs?
All medicines can have side effects. The best way to reduce your risk of side effects is to take your medicine as prescribed, be aware of the potential side effects, and report these changes to your doctor. NSAIDs are safest when the lowest possible doses are taken for the shortest duration. Although NSAIDs are reasonably safe medications, it is important that you are familiar with the most common side effects, especially if you need to take NSAIDs chronically (for months or years). The side effects can range from mild (they go away spontaneously with reduction of the dose), to life threatening (which requires hospitalization).

The most common side effects of NSAIDs

The most common side effects of NSAIDs are stomach upset, heartburn, ulcers, and skin rashes. Taking NSAIDs with food may help prevent some of these problems. Your chances of having these side effects are greater if you take large doses of NSAIDs or take them for a long time.

Less common side effects include confusion; swelling of the face, feet, or lower legs; or a sudden decrease in the amount of urine. These side effects are more likely to occur in older adults and people with other serious health problems.

Aspirin, unlike other NSAIDs, has been shown to reduce the risk of heart attack and stroke. If you use other NSAIDs regularly, aspirin may not work as well to prevent a heart attack and stroke. Do not give aspirin to anyone younger than 20 unless your doctor tells you to. It has been linked to Reye syndrome, a rare but serious illness.

If you are pregnant, trying to become pregnant, or breast-feeding, talk to your doctor before you use NSAIDs. Do not use NSAIDs during pregnancy unless your doctor tells you to. They can cause problems with your baby or with delivery.

Who is more likely to develop ulcers while taking NSAIDs?
It is impossible to predict if someone will develop an ulcer while taking NSAIDs. However, several factors may place a person at high risk for developing an ulcer while taking NSAIDs:

• Over 65 years old
• Previous history of stomach ulcers
• Multiple medical problems
• Use of prednisone or blood thinning medication when taking NSAIDs
• Kidney failure (partial or complete)