Understanding How NSAIDs Work

• Prostaglandin plays a role in pain and inflammation but it also works to shield the delicate lining of your stomach and gastrointestinal (GI) tract from being ravaged by the effects of stomach acid. They also activate your blood platelets to encourage clotting and play a role in healthy kidney function. The production of prostaglandin is governed by a set of enzymes which are called COX (cyclooxygenase). Both COX-1 and COX-2 produce the inflammatory prostaglandins but COX-1 also manufactures protective prostaglandins. Because NSAID medications inhibit both enzymes from working to produce prostaglandin, your inflammation and pain is reduced, but so is your level of protection.
  
  

Risks of NSAID Usage

• The most common risk associated with NSAID use is experiencing side effects like rash, diarrhea, vomiting, constipation, nausea, diminished appetite, dizziness, headache and drowsiness.
  
  NSAID use may also result in edema (fluid retention/swelling) in your legs and arms.
  
  The risk of a severe allergic reaction is more common in patients who have asthma.
  
  The most serious risks associated with NSAID usage include kidney failure, liver failure, ulcers, internal bleeding and perforation of the intestines or stomach.
  With the exception of aspirin, NSAID use increases your risk of cardiac problems (like stroke or heart attack). The risk increases if you have a history of heart disease and may increase with long-term use.
  
  

Risk of Drug Interaction

• To help reduce your risk of adverse medication interactions, tell your doctor about all medications that you are currently taking (including over-the-counter medications, vitamins and herbal supplements). NSAID medications may interact with several medications like blood pressure medications, lithium, methotrexate, diuretics and warfarin.
  
  

Commonly Used NSAIDs

• Commonly used NSAIDs include over-the-counter medications like ibuprofen, aspirin and naproxen. Commonly prescribed NSAIDs include Celebrex, Indocin, Lodine, Voltaren, Orudis, Daypro, Toradol, Relafen, Clinoril, Feldene and Tolectin.
  
  Differences in the way some of these medications work may pose an increased risk or make them more beneficial. For example, aspirin therapy is helpful in the prevention of blood clots; thereby reducing your risk of stroke and heart attack. Toradol is powerful and has an increased risk of ulcer (more so than the other NSAID medications); therefore, it is usually only used short-term (no longer than 5 days). Celebrex works by blocking the COX-2 enzymes but does not have a profound effect on COX-1.
  
  

Managing Your Risks

• According to the AGA's (American Gastroenterological Association) 2006 "Reduce" campaign, more than 30 million people take NSAIDs each day. While the medications are generally well tolerated, they do pose a risk for serious health problems. Taking increased dosages, taking the medication more frequently than recommended and combining several medications containing NSAIDs all increase your risk of developing an adverse reaction.
  
  If you are taking NSAID medications, you should be aware of the warning signs that you may be having a serious problem. If you notice any of the following, contact your health professional at once: abdominal pain; bloody, dark or tar-like stools or vomiting blood.
  
  Talk to your doctor before taking any NSAIDs to evaluate your personal risk for potential problems. Follow the dosing instructions and do not take the medication more frequently than is recommended.