Nonsteroidal anti-inflammatory drugs (NSAIDs), nonselective inhibitors of the cyclo-oxygenase (COX-1 and COX-2) enzymes

Drugs in this class include diclofenac (Cataflam, Voltaren), ibuprofen (Advil, Motrin), ketoprofen (Orudis), naproxen (Aleve, Naprosyn), piroxicam (Feldene), etodolac (Lodine), indomethacin, oxaprozin (Daypro), nabumetone (Relafen), and meloxicam (Mobic).

How NSAIDs work: NSAIDs prevent the body from producing prostaglandins, which have been identified as a cause of pain and inflammation. They do this by inhibiting the COX (cyclo-oxygenase) enzymes that are important in the formation of prostaglandins by cells. Several types of anti-inflammatory agents exist. Doctors recommend NSAIDs as the first type of medicine to try after the initial diagnosis of rheumatoid arthritis is made. Some of these drugs may be purchased without a prescription.

Who should not use these medications: People with the following conditions should not use NSAIDs:

• Allergy to NSAIDs



• Peptic ulcer disease



• Bleeding disorders



• Kidney function impairment

Use: NSAIDs are taken as oral tablets, capsules, or liquid suspension in various dosage regimens. Take them with food to decrease stomach irritation.

Drug or food interactions: Individuals taking anticoagulants (for example, warfarin [Coumadin]) should be monitored for increased bleeding. NSAIDs may cause fluid retention, thereby decreasing the effectiveness of high blood pressure medications and diuretics (water pills). Phenytoin (Dilantin) or methotrexate (Rheumatrex) toxicity may increase when NSAIDs are used. Use with corticosteroids (for example, prednisone [Deltasone, Orasone]) or high doses of aspirin may increase the risk of developing peptic ulcers or gastrointestinal bleeding. Some NSAIDs interfere with aspirin when taken to prevent heart disease.

Side effects: NSAIDs must be used with caution in people with a history of peptic ulcer disease. By inhibiting prostaglandin formation in the GI tract, these NSAIDs may predispose to gastropathy that can lead to stomach erosions, ulcers, and bleeding. NSAIDs can cause fluid retention and worsen some conditions such as heart failure, high blood pressure, kidney impairment, or liver impairment. Do not use NSAIDs during the last 3 months of pregnancy. Call a doctor if any of the following occur:

• Severe stomach pain



• Bloody vomit



• Bloody or black, tarry stools



• Bloody or cloudy urine



• Unexplained bruising or bleeding



• Wheezing or breathing troubles



• Swelling in the face or around the eyes



• Severe rash or red, itchy skin