What are NSAIDs?

Non-steroidal anti-inflammatory drugs are commonly known as NSAIDs or just ‘anti-inflammatories’. They are a group of medicines used for relieving mild to moderate pain, reducing fever or high temperature, and reducing inflammation. As the name suggests, NSAIDs do not contain steroids. The painkilling effects of NSAIDs begin quickly, but the anti-inflammatory effect takes longer. Common NSAIDs include ibuprofen, naproxen, ketoprofen and mefenamic acid.

What are NSAIDs used for?

NSAIDs are commonly used to treat the symptoms of pain and stiffness in osteoarthritis and rheumatoid arthritis, muscle sprains and strains, headaches and period pain.

How do NSAIDs work?

NSAID drugs work by reducing the production of prostaglandins – substances the body produces in response to injury or infection. Prostaglandins are involved in pain (by sensitising nerve endings), swelling and inflammation. NSAIDs reduce prostaglandins by blocking enzymes called COX enzymes, which are involved in making prostaglandins.

The reduction in prostaglandins results in the pain-killing effect and decreased inflammation, as well as taking down a fever.

There are 2 types of COX enzymes: COX-1 and COX-2. They both produce prostaglandins that promote inflammation, pain and fever. But COX-1 has some beneficial aspects, too. It helps protect the lining of the stomach.

Most NSAIDs are non-selective and block both COX-1 and COX-2 enzymes. But there are some NSAIDs that only block COX-2. These selective NSAIDs are called COX-2 inhibitors or coxibs  and are less likely to cause stomach ulcers or irritation.

Anti-inflammatory medicines in Australia

Many different types of NSAIDs are available in Australia. Most are available on prescription and some can be bought over the counter in pharmacies or in supermarkets in low doses without a prescription. Each medicine may be available under different brand names. The NSAID list below is split into non-selective NSAIDs and COX-2 inhibitors.

NSAIDs are most commonly taken by mouth, as tablets, but they are also available as creams and gels and suppositories.

Non-selective NSAIDs

Non-selective NSAIDs
Generic name Brand names in Australia
diclofenac APO-Diclofenac, Chemists’ Own Anti-inflammatory Pain Relief, Chemists’ Own Diclofenac 25 Liquid Capsules, Clonac Tablets, Diclofenac Amneal Tablets, Diclofenac Sandoz, Fenac 25 Tablets, Fenac 50 Tablets, Pharmacor Diclofenac 50, Viclofen, Voltaren Rapid, Voltaren Suppositories, Voltaren Tablets
ibuprofen Advil, Brufen, Nurofen, Nurofen Zavance, Nurofen for Children, Nurofen Quickzorb, Rafen, APO-Ibuprofen, Bugesic Oral Suspension, Chemists’ Own Ibuprofen Pain & Fever Suspension, Chemists’ Own Ibuprofen tablets, Dimetapp Children’s Pain & Fever Relief Ibuprofen Oral Suspension, Dimetapp Infants Pain & Fever Relief Ibuprofen Colour Free Oral Suspension, FenPaed, Gold Cross Ibuprofen Tablets, Pharmacy Action Ibuprofen
ibuprofen + codeine APOHealth Ibuprofen Plus Codeine, Brufen Plus, Ibudeine, Nurofen Plus, Panafen Plus, Sandoz Ibuprofen Plus Codeine Tablets, Trust Ibuprofen Plus Codeine Tablets
paracetamol + ibuprofen Maxigesic, Nuromol, Combigesic Tablets, Ibupane, Mersynofen
indomethacin Arthrexin, Indocid Capsules, Indocid Suppositories
ketoprofen Orudis, Oruvail
ketorolac Toradol
mefenamic acid Ponstan
naproxen Anaprox, Chemists’ Own Period Pain Relief Tablets, Crysanal Tablets, Inza, Naprogesic, Naprosyn, Naproxen SR, Naproxen Suspension, Pharmacy Action Period Pain Relief Tablets, Proxen SR
piroxicam APO-Piroxicam, Feldene Capsules, Feldene-D Tablets, Feldene Gel, Mobilis
sulindac Aclin Tablets

COX-2 inhibitors (coxibs)

COX-2 inhibitors (coxibs)
Generic name Brand names in Australia
celecoxib APO-Celecoxib, Blooms the Chemist Celecoxib, Celaxib, Celebrex, Celecoxib BTC, Celecoxib GH, Celecoxib RBX, Celecoxib Sandoz, Celexi, Chemmart Celecoxib Capsules, GenRx Celecoxib Capsules, Terry White Chemists Celecoxib Capsules
etoricoxib Arcoxia
parecoxib Parecoxib JPL
meloxicam APO-Meloxicam, Chemmart Meloxicam Capsules, Chemmart Meloxicam Tablets, Cipla Meloxicam Tablets, Melobic Capsules, Melox Capsules, Meloxiauro Tablets, Meloxibell Tablets, Meloxibindo Tablets, Meloxicam AN Tablets, Meloxicam Ranbaxy Tablets, Meloxicam Sandoz, Mobic, Movalis, Moxicam, Pharmacor Meloxicam, Terry White Chemists Meloxicam

What’s the difference between NSAIDs and paracetamol?

Both paracetamol and NSAIDs offer short-term pain relief, but NSAIDs (as the name suggests) reduce inflammation, whereas paracetamol does not have much anti-inflammatory effect.

There are some combination painkillers that contain both an NSAID (ibuprofen in these formulations) and paracetamol.

What’s the best NSAID?

People respond differently to different NSAIDs. You may find you have better pain relief with one NSAID than another. Similarly, you may be more or less affected by side effects, with one NSAID than another. There can be considerable variation in a person’s response to different NSAIDs.

Your doctor or pharmacist should be able to advise which is the best choice for you to try, depending on what type of pain you have and your medical history. Remember to tell them about any other medication or complementary medicine you are taking, in case there is an interaction between the medicines.

Can I take NSAIDs in pregnancy?

NSAIDs should be avoided in pregnancy as they increase the risk of miscarriage. An exception to this is low-dose aspirin which may be prescribed to prevent pre-eclampsia. Paracetamol is usually the recommended painkiller in pregnancy.

If you have pain during pregnancy or breastfeeding, don’t suffer unnecessarily. Ask your doctor or pharmacist what is the most appropriate pain relief medication for you.

Are anti-inflammatory drugs safe?

Generally, most people can take NSAIDs without any side effects, but there are some serious effects that can occur. It’s recommended to take the lowest dose that relieves your symptoms for the shortest possible time, to reduce the risk of side effects. People who take NSAIDs for conditions with fluctuating symptoms may not need to take the anti-inflammatories when their symptoms are OK.

Some of the serious possible side effects of NSAIDs are:

  • Stomach ulcers or bleeding of the stomach lining
  • Increased risk of heart attack or stroke

For that reason, you should check the precautions and instructions for each NSAID you take by reading the individual Consumer Medicines Information document. Your doctor or pharmacist will also be able to advise you. This is especially important if you have or have had any heart or blood vessel disease, such as angina, heart attack, stroke, or narrowed arteries to the brain, or you have had stomach irritation or stomach or duodenal ulcers.

Who should not take NSAIDs?

If you have a past history of a stomach or duodenal ulcer or have kidney disease, liver cirrhosis or heart failure, you should consult your doctor before taking non-steroidal anti-inflammatories.

Pregnant women, as mentioned, should avoid NSAID medicines, unless on medical advice.

Some people with asthma may suffer from aspirin/NSAID-intolerant asthma. This is not an allergy to the medicines, but it may cause an exacerbation of their asthma symptoms, such as shortness of breath, wheezing or severe runny nose. You may not know that you are sensitive to NSAIDs or aspirin in this way. People with asthma should consult their doctor about the most appropriate pain relief medication for them. People who know they are allergic or sensitive to NSAIDs, including people with aspirin/NSAID-intolerant asthma should not take NSAIDs.

Side-effects of anti-inflammatory drugs

Anti-inflammatory medicines may cause side effects, even when applied as creams or gels to the skin. Some side effects that may occur are:

  • Gastrointestinal symptoms, such as stomach upsets, nausea, diarrhoea or constipation, vomiting, heartburn, indigestion or stomach cramps
  • Dizziness or lightheadedness
  • Headache
  • High blood pressure

Older people are more prone to gastrointestinal problems when taking NSAIDs. The risk is further increased if a person is taking a blood-thinning medicine, such as warfarin, or low-dose aspirin. The same applies to steroids.

As mentioned some people with asthma may suffer an exacerbation of their symptoms.

There are some side effects you should tell your doctor about straightaway

Some side effects are serious and may be life-threatening. If you experience any of the following side effects, please contact your doctor straightaway.

  • Black, tarry or bloody stools
  • Blood in the urine / cloudy urine
  • Severe stomach pain
  • Blood or material looking like coffee grounds in vomit
  • Tinnitus (ringing in the ears)
  • Blurred vision
  • Serious headache
  • Allergic rashes, wheezing or throat swelling.

Can you take NSAIDs long term?

Most NSAID tablets in Australia carry a warning to not use them for more than a few days at a time, unless following medical advice. Because of the potential for adverse effects, the advice is to use the smallest dose that is effective, for the shortest possible time.

Interactions with other medicines

Drug interactions are where one medicine interferes with the action of another drug. It may make the drug more effective or less effective.

Taking NSAIDs when on anticoagulant medicines, like warfarin, heparin or the newer anticoagulants, including dabigatran and rivaroxaban, can result in an increased risk of bleeding.

Generally, any combination of aspirin and another NSAID is not recommended because of the increased risk of stomach bleeding. People who take low-dose aspirin or other anti-platelet medicines, such as clopidogrel, will need to ask their doctor if it’s safe to take another NSAID in addition to the aspirin because there is an increased risk of gastrointestinal bleeding and it may make the low-dose aspirin less effective.

People on blood pressure medicines who take NSAIDs may find that they lose control of their blood pressure. If the NSAID is to be taken ongoing, then your doctor may need to make an adjustment to your blood pressure medication dose.

Is it safe to mix NSAIDs and alcohol?

Drinking alcohol while on NSAIDs may increase the risk of stomach and gut issues even further, including bleeding. The risk of kidney dysfunction is also increased in people taking NSAIDs who drink alcohol.

Can you take too many NSAIDs?

Usually, a large number of NSAID tablets would need to be taken to cause serious toxicity. Nausea and vomiting are some of the common signs from overdose of NSAIDs. The kidneys can be affected, especially in people who are dehydrated. An overdose of mefenamic acid may cause seizures.

Last Reviewed: 27/01/2020

myDr



References

1. Arthritis Australia. Non-steroidal anti-inflammatory drugs (NSAIDs). https://arthritisaustralia.com.au/medication-search/nsaids/
2. Therapeutic Goods Administration. NSAIDs and cardiovascular risks: questions and answers. October 2014. https://www.tga.gov.au/community-qa/nsaids-and-cardiovascular-risks-questions-and-answers
3. Therapeutic Goods Administration. Non-steroidal anti-inflammatory drugs (NSAIDs) review. October 2016. https://www.tga.gov.au/alert/non-steroidal-anti-inflammatory-drugs-nsaids-review
4. Therapeutic Guidelines. Toxicology: nonsteroidal anti-inflammatory drugs. Published July 2012. Therapeutic Guidelines eTG December 2019 edition. https://tgldcdp.tg.org.au/viewTopic?topicfile=toxicology-nonsteroidal-anti-inflammatory-drugs#toc_d1e52
5. National Prescribing Service. https://www.nps.org.au/assets/f4cd8a064d47b62a-0e01df33044e-139fddfcb7c79fd0c38a7065fad62081b237334047fed3a63e4463e31f34.pdf
6. National Asthma Council Australia. Aspirin/NSAID-intolerant asthma: pharmacy notes. https://assets.nationalasthma.org.au/resources/pain_relievers_and_asthma_quick_reference_guide.pdf
7. Cleveland Clinic. Non-steroidal anti-inflammatory drugs (NSAIDs). Last reviewed October 2019. https://my.clevelandclinic.org/health/drugs/11086-non-steroidal-anti-inflammatory-medicines-nsaids
8. eMIMS Cloud Interactions Checker. January 2020. Clopidogrel and Ibuprofen. Aspirin and Ibuprofen. Ibuprofen and Alcohol. eMIMS Cloud. Prescribing information. NSAIDs. January 2020 issue.
9. Smolinske SC, et al. Toxic effects of nonsteroidal anti-inflammatory drugs in overdose. An overview of recent evidence on clinical effects and dose-response relationships. Drug Safety 1990; 5(4): 252-74 https://www.ncbi.nlm.nih.gov/pubmed/2198051

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