What are NSAIDs?
NSAIDs is the abbreviate term given to a group of non-steroidal anti-inflammatory drugs, including aspirin and ibuprofen.
NSAIDs are a type of analgesic painkiller, meaning that they help to relieve pain and have anti-inflammatory benefits to reduce redness, swelling and to bring down a high temperature.
What are NSAIDs used for?
Some NSAIDs (ibuprofen and aspirin) are available over the counter and are used to treat common ailments such as headaches, period pains, sprains, strains, toothache and minor infections.
Other types of NSAIDs are available by prescription to treat long-term (chronic) conditions, such as osteoarthritis, rheumatoid arthritis and back pain. These will require a prescription from your GP.
How do NSAIDs work?
NSAIDs work by blocking enzymes known as cyclo-oxygenase (Cox). There are two types: Cox-1 and Cox-2. Cox-1 is mainly found in the gastrointestinal tract and is needed to maintain the protective lining of the stomach. Cox-2, on the other hand, is found where inflammation occurs.
In single doses, NSAIDs have a pain-killing action comparable to that of paracetamol. In regular full dosage, NSAIDs have both a lasting pain-relieving effect and an anti-inflammatory effect.
What are the side effects of NSAIDs?
COX-1 inhibitors, such as aspirin, and non-selective NSAIDs which inhibit both Cox-1 and Cox-2, such as ibuprofen and naproxen, can sometimes be associated with an increased risk of peptic ulcers and gastric bleeding by suppressing production of intestinal mucus.
NSAIDs that are selective Cox-2 inhibitors (whose generic drug name usually ends in ‘coxib’, such as celecoxib and etoricoxib) have minimal or no risk of causing peptic ulcers. They do, however carry a higher risk of other potential side effects, including heart attack, heart failure, stroke, kidney and liver problems. Some selective Cox-2 inhibitors have already been withdrawn because of these safety concerns.
Although it’s not possible to measure the increased risk precisely, for every thousand people using Cox-2 inhibitors for a year, there may be three additional thrombotic events (heart attack, stroke) as a result. These risks may be lower with non-selective NSAIDs such as naproxen.
How many people are affected by NSAID side effects?
Researchers have estimated that, out of 25 million NSAID prescriptions in the UK, there have been around 12,000 NSAID-related hospital admissions and 2,600 NSAID-related deaths, mostly relating to gastrointestinal haemorrhage.
How can your GP help?
Prescribing an NSAID, especially for long-term health conditions, is based on a careful weighing of the benefits versus the risks. Your GP can tell you if an NSAID is likely to help you, and what alternatives are available. In general, when an NSAID is prescribed, the lowest effective dose is used for the shortest possible time.
How can you help yourself?
Always read the patient information leaflet provided, which lists how to take the drug correctly, who should not take it, and possible side effects. If you are concerned, talk to your GP.
The Medicines and Healthcare Products Regulatory Agency (MHRA) is closely monitoring the safety of all non-selective NSAIDs and coxibs. If you experience a side effect, any patient or health professional in the UK can report this to the MHRA via their YellowCard scheme.
NB if you experience a suspected side effect from any medication, seek advice from a pharmacist or GP as soon as possible.