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Updated April 2019 v2
Non-steroidal anti-inflammatory drugs, or NSAIDs, are common medicines used to treat the symptoms of arthritis. The name means they reduce pain and stiffness due to inflammation of the joints, without using steroids. You can find outabout steroids from the separate ARA information sheet on corticosteroids.
There are many different NSAIDs. Some can be bought over the counter (OTC) e.g. ibuprofen (Nurofen). Others such as ketoprofen (Orudis) are only available with a prescription. The brandname of your NSAID will have the generic name next to it on the packet or bottle. See below for further examples.
NSAIDs stop cells making prostaglandins. Prostaglandins are chemicals released by injured cells. They cause inflammation and swelling and they sensitise nerve endings, which can lead to pain. If you make less prostaglandin, you have less inflammation and less pain. By stopping cells making prostaglandins, NSAIDs relieve the symptoms of arthritis. They do not stop the inflammation occurring in the future or prevent the disease progressing to joint damage.
There are two broad groups of NSAIDs: nonselective and selective. Selective NSAIDs are also called cox 2 inhibitors or coxibs. Selective NSAIDs are less likely than non- selective NSAIDs to cause stomach irritation or stomach ulcers.
NSAIDs provide relief from pain and stiffness. They work quickly, usually within a few hours. The maximum benefit can take 2 to 4 weeks or sometimes longer. You may need to try two or three different NSAIDs to find one that suits you best. You must only take one type of NSAID at a time.
NSAIDs are usually taken by mouth in tablet or capsule form. They are also available as liquids, injections, creams, sprays and suppositories.
Side effects may occur with any method of administration, even when NSAIDs are applied to the skin (see Side effects).
When should they be taken?
NSAIDS can be taken when needed to treat short term symptoms. They can also be taken regularly to manage persistent pain and stiffness.
While NSAIDs may be more effective if taken regularly, the possible side effects are less if they are only taken when needed, for example before exercise.
How often you take a NSAID also depends on the one you are prescribed. Ask your doctor or pharmacist if you are uncertain about how often to take your medicine.
Tablets and capsules should be taken with food to reduce possible side effects.
What is the dosage?
NSAIDs come in different strengths. Treatment usually starts with a low dose.
Your doctor will adjust the dose depending on the type of NSAID, the condition for which it is being used and whether or not your symptoms are relieved.
To minimise side effects, the lowest dose that controls symptoms is usually recommended.
Always follow the instructions provided in the packaging unless otherwise directed by your doctor.
Can other medicines be taken with NSAIDs?
To minimise side effects, sometimes a medicine to protect the stomach may be given (see under Are there any side effects?).
NSAIDs may be used with other arthritis medicines including:
Corticosteroids are not generally used with NSAIDs as the risk of side effects such as stomach irritation or ulcers are increased. There are separate information sheets for the medicines mentioned above.
You should not take more than one NSAID at the same time, including those bought without a prescription (except for low dose aspirin).
How long is the treatment continued?
Due to potential adverse effects with long term treatment, NSAIDs should be used at the minimum effective dose for the shortest possible time. NSAIDs should not be continued indefinitely without regular review by your
You might experience side effects with your treatment. Tell your doctor if you are concerned about possible side effects. A reduction in dose or change to another NSAID may decrease the side effects so that you can continue to take the treatment.
Alternatively, your doctor may recommend a different pain relieving medicine with fewer potential side effects, such as paracetamol. This may allow you take the NSAID less often or stop it altogether.
Most common possible side effects:
The risk of ulcers is higher if:
- you are older than 65 years
- you have had a previous stomach or duodenal ulcer
- you are also taking warfarin or other blood thinners, corticosteroid tablets or low-dose aspirin (used by many people to help prevent a heart attack or stroke).
Your doctor may advise that you take an anti-ulcer medicine to help reduce the risk of getting a stomach or duodenal ulcer.
• Bleeding more easily than usual is often noticed.
• Allergy to NSAIDs can occur resulting in skin rashes or itchiness
• Shortness of breath may occur in some people with asthma (see Precautions)
There are also a number of other uncommon side effects. Read the leaflet that comes with the medicine, which lists all the precautions and possible side effects.
The benefits of NSAIDs outweigh the known risks for most people. However there is a small but significant increased risk of CV adverse effects (such as heart attack, angina or stroke) with both selective and nonselective NSAIDs. The risk is lower with smaller doses of NSAIDs used for shorter periods of time. The risk is higher in those with other CV risk factors such as a previous CV event (e.g. a heart attack), smoking, obesity, high cholesterol or diabetes.
Due to these potential adverse effects, any NSAID should be used in the minimum effective dose and for the shortest possible time.
If you have any questions or concerns about the risks of CV events, discuss the benefits and risks with your GP or rheumatologist.
Use with other medicines
Use with alcohol
Use in pregnancy and breastfeeding