What are anti-inflammatory medications?
- These can be called NSAIDs (non-steroidal anti-inflammatory drugs). Examples include ibuprofen, naproxen, diclofenac, meloxicam, indomethacin, piroxicam and etoricoxib
- Some are available to buy over the counter including ibuprofen. You should inform your doctor if you buy and regularly take an NSAID
- They are available as tablets, capsules, liquids, gels, creams and suppositories. Gels and creams can be rubbed into the skin and may be worth trying first if you have muscle or joint pain in a particular part of your body, as they tend to have fewer side effects than tablets and capsules
- Inside the medication packaging you will find an information leaflet specific to the NSAID that you have been prescribed, this will provide you with detailed information on the specific NSAID you have been prescribed
Why have I been prescribed this?
- NSAIDs are used to treat pain from an injury (e.g. sprained ankle, broken arm) or surgery
- NSAIDs can also be used in long term painful conditions such as osteoarthritis, back pain, rheumatoid arthritis
- Taking NSAIDs may mean that you can reduce some of your other pain medicines such as opioids (e.g. morphine), which leads to fewer side effects
How do NSAIDs work?
- When you experience tissue injury or damage your body produces chemicals called prostaglandins. Prostaglandins are involved in the production of pain and inflammation
- NSAIDs reduce the amount of prostaglandins and therefore reduce pain, inflammation and swelling
When should I take it?
- NSAIDs can be taken regularly or as needed if the pain is not constant
- Oral NSAIDs (taken by mouth e.g. tablets, liquid) should be taken with or shortly after food to protect the stomach and reduce stomach upset. Your prescriber may also prescribe you a medication to reduce irritation to your digestive tract, such as a Proton Pump Inhibitor
- As NSAIDs have a lot of side effects, ideally the lowest effective dose of NSAID should be taken for the shortest period of time to control symptoms
How should I take it?
- NSAIDs come in many different forms including those that can be swallowed such as tablets, capsules and liquids and as suppositories that are inserted into the back passage
- Gels and creams and can be applied to the skin and rubbed into the painful area. They should not be applied to the eyes, mouth, lips, nose or genital area. Do not put on sore or broken skin. Do not put plasters or dressings over skin you have applied the NSAID to
- Do not take more than one NSAID at a time as their effects can add up causing more side effects
How long will it take to work?
- Everyone is different. The average time for pain to reduce is 1 hour after taking a tablet or using a suppository, however it may take up to 1 week for the full pain relieving effect. It can take up to 3 weeks for the full anti-inflammatory effect
- NSAID gels and creams can vary in the time it takes to give pain relief. Ibuprofen gel takes usually takes 1 to 2 days to work
- NSAIDs do not work for everyone. If there is no improvement in your pain you should consult your prescriber. Your prescriber may recommend trying a different NSAID, as some people respond differently to different NSAIDs
What if I forget or miss a dose?
- Take it as soon as you remember, unless it is almost time for your next dose. If it is, skip the missed dose and take your next dose as normal. Do not take two doses together
Can I take it long term?
- Ideally NSAIDs should be taken for the shortest period of time to control symptoms. However, they can be taken for long term conditions – if your prescriber has recommended for you to take an NSAID long term they will review you on an on-going basis to monitor for side effects and effectiveness
What are the possible side effects?
- Most side effects are mild. Side effects are usually related to the dose of medicine you take, but some people are more sensitive than others.
- Side effects are less likely if you can take the smallest dose that you find reduces your pain
- You’re less likely to have side effects when you apply the NSAID gel/ cream to your skin than with tablets, capsules and syrup because less gets into your body. However, you may still get the same side effects, especially if you use a lot on a large area of skin
- Common side effects include heartburn, indigestion, stomach pain and feeling or being sick. If these side effects are frequent or severe you should stop taking the medicine and consult your prescriber or pharmacist
- If you vomit any blood or dark particles that look like coffee grounds or have blood stained faeces (stools) you should stop taking the medicine immediately and seek urgent medical advice
- Less common side effects include headache, dizziness, swollen feet or legs and weight gain. If these side effects are constant and severe discuss with your prescriber or pharmacist. Other less common side effects include a rash or itching, unexplained wheezing or shortness of breath. If you have any of these side effects, you should discuss them with your prescriber or pharmacist
- Even short term NSAID use may be linked to a very small increased risk of having a stroke or heart attack. However your risk of having a stroke or heart attack whilst taking NSAIDS is thought to remain very low. The risk of this increases with higher doses and longer treatment durations. The risk is greater for those who already have heart disease
- If you experience chest pain, shortness of breath or sudden weakness or difficulty speaking whilst taking an NSAID, seek medical help immediately
- Use of NSAIDs, even for a short period of time, can harm the kidneys. This is especially true in people with underlying kidney disease
Can I drink alcohol?
- Once you are settled on a stable dose, you may drink alcohol in moderation. Drinking more than the recommended daily limits should be avoided as this may irritate your stomach and increase the risk of a bleed in your digestive tract
Can I drive?
- Yes, it is usually safe to drive whilst taking a NSAID
- Although not common, NSAIDs may make you dizzy or drowsy. If you experience any of these symptoms do not drive, operate machinery or do anything that requires you to be alert
- NSAID use is associated with a very small increased risk of motor vehicle accidents. It is not clear if the increased risk is a result of medicine related side effects, or the underlying pain condition, however NSAID information leaflets produced by manufacturers warn of caution when driving or using heavy machinery
What should I tell my doctor/pharmacist/pain team?
- If you are allergic to any medicines
- If you are taking any other prescribed medicines, bought from the pharmacy or herbal medicines
- If you are taking another NSAID, low dose aspirin or warfarin, ciclosporin, diuretics (water tablets sometimes used to treat high blood pressure), lithium, methotrexate, antidepressants called selective serotonin reuptake inhibitors such as citalopram and fluoxetine, or steroids such as prednisolone
- If you are pregnant or breastfeeding, or if you are planning to become pregnant in the future
- If you have:
- a stomach ulcer or have had one before
- a kidney or liver problem
- asthma or any other breathing disorder
- any problem with bleeding or blood clots
- Crohn’s disease or ulcerative colitis
- high blood pressure
- had a heart attack, suffer with angina or have recurrent chest pains
- have shortness of breath, fatigue, swelling in legs, ankles or feet, or other symptoms of heart failure
- had a stroke
- dementia or Parkinson’s disease
What if I want to stop taking it?
- Over time your pain may change. It is important to regularly review whether you still need to use your NSAID medicine
- If your pain improves, you should consider stopping your medicine or reducing the dose as any medicine can have unwanted side effects
- You can safely stop your NSAID whenever you want to but it is best to discuss this with your prescriber if you have been taking the NSAID for a long time