Harvard Health Blog
You might call them pain relievers. You might take them for back pain, headache, or arthritis. Your doctor calls them “NSAIDs,” which stands for nonsteroidal anti-inflammatory drugs. Whatever you call them and for whatever reason you take them, NSAIDs are among the most popular medications worldwide. In fact, estimates suggest that about 15 percent of the US population takes an NSAID regularly (including those that are over the counter and prescription strength). Along with sporadic users, more than 30 billion doses are taken each year.
Some of the most common anti-inflammatory drugs include ibuprofen (as in Motrin), naproxen (as in Aleve) and celecoxib (as in Celebrex).
Why are anti-inflammatory meds so popular?
There are several reasons:
–For many conditions, they work quite well — in addition to working as pain relievers, they can reduce fever and inflammation.
–They are relatively inexpensive, with generic versions available for most of them.
–They’re available over the counter or, in higher doses, by prescription.
–They have a good safety profile.
The downside of anti-inflammatory meds
No medication is completely safe, and that’s certainly true of NSAIDs. At the top of the list are digestive problems including stomach upset, heartburn and ulcers. Kidney injury, easy bruising or bleeding and mild allergic reactions (such as rash) are common as well. Less common side effects, including severe allergic reactions and liver injury, can be serious. NSAIDs can also raise the risk of heart problems, though this risk varies depending on the particular NSAID and the person taking it. Still, the vast majority of people taking NSAIDs in the recommended doses who have appropriate monitoring (such as the occasional blood test) have no major problems with them.
It’s easy for things to go wrong
The widespread availability and good safety record of NSAIDs makes it easy to misuse them. For one thing, there are more than 20 different NSAIDs, so you could be taking more than one of them without realizing it. In addition, several of them are available over the counter and are included in combination with other medications. Examples include prescription drugs like Arthrotec (a combination of the NSAID diclofenac and misoprostol, a medication that helps protect the stomach) and products available on the drugstore shelf, like Advil PM (ibuprofen plus the antihistamine diphenhydramine). So whether intentionally or by accident, it’s easy to take more than recommended doses.
A recent study finds that this may be a bigger problem than anyone realized. Among more than 1,300 people taking ibuprofen:
–More than one-third also took a second NSAID. Less than half of these “double NSAID” users realized that more than one of their medications was an NSAID.
–Up to 15 percent took more than the recommended dosage.
–Exceeding the recommended maximum dose was especially common among men, those with chronic pain, those with poor knowledge of dosing recommendations, and those who believed in “choosing my own dose.”
The bottom line
NSAIDs can be remarkably helpful medications, but they can cause trouble. The risk of serious side effects goes up when taken in higher than recommended doses.
Except for low-dose aspirin (commonly taken to prevent heart attack or stroke), NSAIDs are taken primarily to relieve symptoms of pain or fever. If you don’t think your NSAID is helping you (or if you aren’t sure), talk to your doctor about stopping it — even minor risks aren’t worth taking if there’s no benefit. Or there may be a better option, such as acetaminophen (as in Tylenol).
Keep an updated list of all of the medications you take, including over-the-counter drugs. Read the labels and instructions and take them only as prescribed. When in doubt, ask your doctor or pharmacist.
(Robert H. Shmerling, M.D., is a faculty editor for Harvard Health Publishing.)
