How do prescription nonsteroidal anti-inflammatory drugs work?

Nonsteroidal anti-inflammatory drugs (also called NSAIDs) stop cyclooxygenase enzymes (also called COX enzymes) in your body from working. COX enzymes speed up your body's production of hormone-like substances called prostaglandins. Prostaglandins cause the feeling of pain by irritating your nerve endings. They are also part of the system that helps your body control its temperature.

By reducing the level of prostaglandins in your body, NSAIDs help relieve pain from conditions like arthritis. They also help reduce inflammation (swelling), lower fevers and prevent blood from clotting.

What are some common prescription NSAIDs?

There are 2 classes of prescription NSAIDs.

Traditional NSAIDs include the following:

• Diclofenac (brand names: Cataflam, Voltaren)

• Etodolac (brand name: Lodine)

• Fenoprofen (brand name: Nalfon)

• Flurbiprofen (brand name: Ansaid)

• Ibuprofen (2 brand name: Advil, Motrin)

• Indomethacin (brand name: Indocin)

• Ketoprofen (brand names: Orudis, Oruvail)

• Meclofenamate

• Meloxicam (brand name: Mobic)

• Nabumetone (brand name: Relafen)

• Naproxen (brand names: Anaprox, Naprelan, Naprosyn)

• Oxaprozin (brand name: Daypro)

• Piroxicam (brand name: Feldene)

• Sulindac (brand name: Clinoril)

• Tolmetin (brand name: Tolectin)

COX-2 inhibitors include celecoxib (brand name: Celebrex).

If you need to take a prescription NSAID, your doctor will help you find one that is right for you.

What's the main difference between traditional NSAIDs and COX-2 inhibitors?

You have 2 types of COX enzymes in your body: COX-1 and COX-2. Researchers believe that one of the jobs of COX-1 enzymes is to help protect your stomach lining. The COX-2 enzyme doesn't play a role in protecting your stomach.

Traditional NSAIDs stop both COX-1 and COX- 2 enzymes from doing their jobs. When COX-1 enzymes are blocked, pain and inflammation is reduced, but the protective lining of your stomach is also reduced. This can cause problems such as upset stomach, ulcers and bleeding in your stomach and intestines.

COX-2 inhibitors only stop COX-2 enzymes from working. Since the COX-2 enzyme doesn't help to protect your stomach, COX-2 inhibitors may be less likely to irritate your stomach or intestines.

Do prescription NSAIDs have any side effects?

Like all medicines, these drugs can cause side effects. However, the side effects usually are not severe and are not experienced very often.

Common side effects of prescription NSAIDs may include the following:

• Dizziness or headache

• Nausea, excess gas, diarrhea or constipation

• Extreme tiredness or weakness

• Dry mouth

Serious side effects of prescription NSAIDs may include the following:

• Allergic reaction, such as difficulty breathing, hives, swelling of the lips, tongue or face

• Muscle cramps, numbness or tingling

• Rapid weight gain

• Black, bloody or tarry stools

• Blood in urine or vomit

• Decreased hearing or ringing in the ears

• Yellowing of skin and eyes (jaundice)

• Abdominal cramping, heartburn or indigestion

In addition to the side effects listed above, people taking a COX-2 inhibitor may be at risk for the following side effects:

• Swelling or water retention

• Skin rash or itching

• "Flu-like" symptoms

• Unusual bruising or bleeding

• Difficulty sleeping (insomnia)

Call your doctor as soon as possible if your side effects become severe.

Is it safe to take NSAIDs for a long period of time?

People who take NSAIDs increase their risk for severe bleeding in their stomachs. They may also be at risk for heart attacks and strokes. These risks gets worse if they take higher doses or if they take these medicines for a long period of time. Patients who need to take pain medicine for longer than a week should discuss this risk and explore other pain treatment options with their family doctor.

What is a drug interaction?

If you use 2 or more drugs at the same time, the way your body processes each drug can change. When this happens, the risk of side effects from each drug increases and each drug may not work the way it should. This is called a "drug-drug interaction." Vitamins and herbal supplements can affect the way your body processes drugs too.

Certain foods or drinks can also prevent your medicine from working the way it should or make side effects worse. This is called a "drug-food interaction." For example, if you're taking a traditional NSAID, drinking alcohol can increase your risk of liver disease or stomach bleeding.

Drug-drug interactions and drug-food interactions can be dangerous. Be certain that your doctor knows all of the over-the-counter and prescription medicines, vitamins and herbal supplements that you are taking. Also, talk to your doctor before you take any new over-the-counter or prescription medicine or use a vitamin or herbal supplement.

It's important to take medicines exactly as your doctor tells you to. Ask your doctor whether you need to avoid any foods or drinks while using a prescription NSAID.

Postoperative pain medications

Nonsteroidal anti-inflammatory drugs and opioid analgesics are two common types of postsurgical pain medications. Depending on the type and extent of your surgery and the amount of pain you experience, your doctor may use one or both of these for pain reduction.

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More Pain Relief Resources:

• Overviews
• Medications and Chronic Pain (American Chronic Pain Association) - Large PDF file
• Pain Medicines (Cleveland Clinic Foundation)
• Pain Treatment (Merck & Co., Inc.)

• Specific Conditions
• Chronic Pain Medicines (American Academy of Family Physicians)
  Also available in: Spanish
• Injection Therapy: Relieving Pain at the Source (Mayo Foundation for Medical Education and Research)
• Nerve Blocks (Cleveland Clinic Foundation)
• Pain Medications: Guide to Over-the-Counter Options (Mayo Foundation for Medical Education and Research)
• Pain Relievers: Understanding Your OTC Options (American Academy of Family Physicians)
• Patient-Controlled Analgesia (PCA) Pump (Cleveland Clinic Foundation)
• Prescription Pain Medicines (American Academy of Family Physicians)
  Also available in: Spanish
• Topical Painkillers: Rubbing in Relief (Mayo Foundation for Medical Education and Research)

• Related Issues
• After Surgery: Medications and Methods for Pain Relief (Mayo Foundation for Medical Education and Research)
• Analgesic Nephropathy (Painkillers and the Kidneys) (National Institute of Diabetes and Digestive and Kidney Diseases)
• Are COX-2 Drugs Safe for You? (Mayo Foundation for Medical Education and Research)
• Aspirin for Reducing Your Risk of Heart Attack and Stroke: Know the Facts (Center for Drug Evaluation and Research)
• Best Way to Take Your Over-the-Counter Pain Reliever? Seriously. (Center for Drug Evaluation and Research)
• Common Terms on Over-the-Counter Pain Relievers: What Do They Mean? (Mayo Foundation for Medical Education and Research)
• Dangers of Aspirin and NSAIDS (American College of Gastroenterology)
  Also available in: Spanish
• NSAIDs and Peptic Ulcers (National Institute of Diabetes and Digestive and Kidney Diseases)
• NSAIDs: How to Avoid Side Effects (Mayo Foundation for Medical Education and Research)
• Proper Use of Fentanyl Pain Patches (Food and Drug Administration)
• Questions and Answers on COX-2 Selective and Non-Selective Non-Steroidal Anti-Inflammatory Drugs (Center for Drug Evaluation and Research)
• Treating Osteoarthritis and Pain: The Non-Steroidal Anti-Inflammatory Drugs (Consumers Union of U.S.)
  Also available in: Spanish

• Research
• More Studies on Risk and Benefits of COX-2 Inhibitors (01/28/2005, American Medical Association)

• Organizations
• Center for Drug Evaluation and Research
• Food and Drug Administration
• Institute for Safe Medication Practices

• Children
• Acetaminophen: Watch Dosage for Children (Mayo Foundation for Medical Education and Research)
• How Do Pain Relievers Work? (Nemours Foundation)

• Women
• Aspirin (Center for the Evaluation of Risks to Human Reproduction)