NSAIDs

Non-steroidal anti-inflammatory drugs (NSAIDs) are medications widely used to relieve pain, reduce inflammation, and bring down a high temperature (fever).

They're often used to relieve symptoms of headaches, painful periods, sprains and strains, colds and flu, arthritis, and other causes of long-term pain.

Although NSAIDs are commonly used, they're not suitable for everyone and can sometimes cause troublesome side effects.

This information is a general overview of NSAIDs. For information about a specific medicine, you can look up your medication on the Medicines and Healthcare products Regulatory Agency (MHRA) website.

Types of NSAIDs

NSAIDs are available as tablets, capsules, suppositories (capsules inserted into the bottom), creams, gels and injections.

Some can be bought over the counter from pharmacies, while others need a prescription.

The main types of NSAIDs include:

• ibuprofen
• naproxen
• diclofenac
• celecoxib
• mefenamic acid
• etoricoxib
• indometacin
• high-dose aspirin (low-dose aspirin isn't normally considered to be an NSAID)

NSAIDs may be sold under these names or a brand name. They're all similarly effective, although you may find a particular one works best for you.

Who can take NSAIDs?

Most people can take NSAIDs, but some people need to be careful about taking them.

It's a good idea to ask a pharmacist or doctor for advice before taking an NSAID if you:

• are over 65 years of age
• are pregnant or trying for a baby
• are breastfeeding
• have asthma
• have had an allergic reaction to NSAIDs in the past
• have had stomach ulcers in the past
• have any problems with your heart, liver, kidneys, blood pressure, circulation, or bowels
• are taking other medications
• are looking for medication for a child under 16 (any medication that contains aspirin shouldn't be given to children under 16)

NSAIDs might not necessarily need to be avoided in these cases, but they should only be used on the advice of a healthcare professional as there may be a higher risk of side effects.

If NSAIDs aren't suitable, your pharmacist or doctor may suggest alternatives to NSAIDs, such as paracetamol.

Side effects of NSAIDs

Like all medications, there's a risk of side effects from NSAIDs. These tend to be more common if you're taking high doses for a long time, or you're elderly or in poor general health.

Over-the-counter NSAIDs generally have fewer side effects than stronger prescription medicines.

Possible side effects of NSAIDs include:

• indigestion – including stomach aches, feeling sick and diarrhoea
• stomach ulcers – these can cause internal bleeding and anaemia; extra medication, such as proton pump inhibitors (PPIs), may be prescribed to help reduce this risk
• a hole forming in the wall of your stomach or bowel
• headaches
• drowsiness
• dizziness
• allergic reactions
• in rare cases, problems with your liver, kidneys, or heart and circulation, such as heart failure, heart attacks and strokes

If you experience any troublesome side effects, stop taking your medicine and tell your doctor.

Interactions with other medicines

Some NSAIDs can react unpredictably with other medications. This can affect how well either medicine works and increase the risk of side effects.

It's particularly important to get medical advice before taking an NSAID if you're already taking:

• another NSAID
• low-dose aspirin or warfarin – medicines used to prevent blood clots
• ciclosporin – a medicine used to treat autoimmune conditions such asarthritis or ulcerative colitis
• diuretics – medicines sometimes used to treat high blood pressure
• lithium – a medicine used to treat bipolar disorder and severe depression
• methotrexate – a medicine used to treat rheumatoid arthritis
• a type of antidepressant medicine called a selective serotonin reuptake inhibitor (SSRI)

For information about a specific medicine, check the A-Z of medicine leaflets on the MHRA website.

Generally, you don't need to avoid any specific foods while taking NSAIDs. Tablets or capsules should normally be swallowed with water or food to stop them upsetting your stomach.

It's usually safe to drink alcohol while taking NSAIDs, but drinking alcohol excessively during treatment may irritate your stomach.

Overdoses of NSAIDs

Taking too much of an NSAID can be dangerous. This is known as taking an overdose.

Contact your GP or NHS 111 for advice immediately if you take too much of your medicine and you experience problems such as feeling or being sick, an upset stomach, or drowsiness.

Call 999 for an ambulance immediately if you or someone else experiences serious effects of an overdose, such as fits (seizures), breathing difficulties, or loss of consciousness.

Alternatives to NSAIDs

As NSAIDs can cause troublesome side effects, alternatives are often recommended first.

The main alternative for pain relief is paracetamol, which is available over the counter and is safe for most people to take.

NSAID creams and gels that you rub into your skin 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 or capsules.

Your doctor may also be able to recommend different medicines and therapies depending on the condition you have. For example, physiotherapy may help some people with muscle or joint pain.