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Anti-Inflammatory Drugs, Nonsteroidal (Systemic)

Contents of this page:

Brand Names

Some commonly used brand names are:

In the U.S.--

In Canada--

Other commonly used names are: Etodolic acid Indometacin Meclofenamic acid

Note:

For quick reference, the following nonsteroidal anti-inflammatory drugs are numbered to match the corresponding brand names.
This information applies to the following medicines:
1. Diclofenac (dye-KLOE-fen-ak)
2. Diflunisal (dye-FLOO-ni-sal)$
3. Etodolac (ee-TOE-doe-lak)+
4. Fenoprofen (fen-oh-PROE-fen)$
5. Floctafenine (flok-ta-FEN-een)*
6. Flurbiprofen (flure-BI-proe-fen)$&
7. Ibuprofen (eye-byoo-PROE-fen)$&
8. Indomethacin (in-doe-METH-a-sin)$
9. Ketoprofen (kee-toe-PROE-fen)$
10. Meclofenamate (me-kloe-FEN-am-ate)+$
11. Mefenamic Acid (me-fe-NAM-ik)
12. Meloxicam (mel-OX-i-cam)$
13. Nabumetone (na-BYOO-me-tone)
14. Naproxen (na-PROX-en)$
15. Oxaprozin (ox-a-PROE-zin)
16. Phenylbutazone (fen-ill-BYOO-ta-zone)$
17. Piroxicam (peer-OX-i-kam)$
18. Sulindac (sul-IN-dak)$
19. Tenoxicam (ten-OX-i-kam)*
20. Tiaprofenic Acid (tie-a-pro-FEN-ik)*
21. Tolmetin (TOLE-met-in)$
* Not commercially available in the U.S.
+ Not commercially available in Canada
$ Generic name product may be available in the U.S.
& Generic name product may be available in Canada

This information does not apply to aspirin or other salicylates or to ketorolac (e.g., Toradol).

Category

Description

Nonsteroidal anti-inflammatory drugs (also called NSAIDs) are used to relieve some symptoms caused by arthritis (rheumatism), such as inflammation, swelling, stiffness, and joint pain. However, this medicine does not cure arthritis and will help you only as long as you continue to take it.

Some of these medicines are also used to relieve other kinds of pain or to treat other painful conditions, such as:

Ibuprofen and naproxen are also used to reduce fever.

Meclofenamate is also used to reduce the amount of bleeding in some women who have very heavy menstrual periods.

Nonsteroidal anti-inflammatory drugs may also be used to treat other conditions as determined by your doctor.

Any nonsteroidal anti-inflammatory drug can cause side effects, especially when it is used for a long time or in large doses. Some of the side effects are painful or uncomfortable. Others can be more serious, resulting in the need for medical care and sometimes even death. If you will be taking this medicine for more than one or two months or in large amounts, you should discuss with your doctor the good that it can do as well as the risks of taking it. Also, it is a good idea to ask your doctor about other forms of treatment that might help to reduce the amount of this medicine that you take and/or the length of treatment.

One of the nonsteroidal anti-inflammatory drugs, phenylbutazone, is especially likely to cause very serious side effects. These serious side effects are more likely to occur in patients 40 years of age or older than in younger adults, and the risk becomes greater as the patient's age increases. Before you take phenylbutazone, be sure that you have discussed its use with your doctor. Also, do not use phenylbutazone to treat any painful condition other than the one for which it was prescribed by your doctor .

Although ibuprofen and naproxen may be used instead of aspirin to treat many of the same medical problems, they must not be used by people who are allergic to aspirin.

The 200-mg strength of ibuprofen and the 220-mg strength of naproxen are available without a prescription. However, your health care professional may have special instructions on the proper dose of these medicines for your medical condition.

Other nonsteroidal anti-inflammatory drugs and other strengths of ibuprofen and naproxen are available only with your medical doctor's or dentist's prescription. These medicines are available in the following dosage forms:


Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your health care professional will make. For the nonsteroidal anti-inflammatory drugs, the following should be considered:

Allergies--Tell your health care professional if you have ever had any unusual or allergic reaction to any of the nonsteroidal anti-inflammatory drugs, or to any of the following medicines:

Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Diet--Make certain your health care professional knows if you are on any special diet, such as a low-sodium or low-sugar diet. Some of these medicines contain sodium or sugar.

Pregnancy--Studies on birth defects with these medicines have not been done in humans. However, there is a chance that these medicines may cause unwanted effects on the heart or blood flow of the fetus or newborn baby if they are taken regularly during the last few months of pregnancy. Also, studies in animals have shown that these medicines, if taken late in pregnancy, may increase the length of pregnancy, prolong labor, or cause other problems during delivery. If you are pregnant, do not take any of these medicines, including nonprescription (over-the-counter [OTC]) ibuprofen or naproxen, without first discussing its use with your doctor.

Studies in animals have not shown that fenoprofen, floctafenine, flurbiprofen, ibuprofen, ketoprofen, nabumetone, naproxen, phenylbutazone, piroxicam, tiaprofenic acid, or tolmetin causes birth defects. Diflunisal caused birth defects of the spine and ribs in rabbits, but not in mice or rats. Diclofenac and meclofenamate caused unwanted effects on the formation of bones in animals. Etodolac and oxaprozin caused birth defects in animals. Indomethacin caused slower development of bones and damage to nerves in animals. In some animal studies, sulindac caused unwanted effects on the development of bones and organs. Studies on birth defects with mefenamic acid have not been done in animals.

Even though most of these medicines did not cause birth defects in animals, many of them did cause other harmful or toxic effects on the fetus, usually when they were given in such large amounts that the pregnant animals became sick.

Breast-feeding--

Although other anti-inflammatory analgesics have not been reported to cause problems in nursing babies, diclofenac, diflunisal, fenoprofen, flurbiprofen, meclofenamate, mefenamic acid, naproxen, piroxicam, and tolmetin pass into the breast milk. It is not known whether etodolac, floctafenine, ibuprofen, ketoprofen, nabumetone, oxaprozin, sulindac, or tiaprofenic acid passes into human breast milk.

Children--

Most of these medicines, especially indomethacin and phenylbutazone, can cause serious side effects in any patient. Therefore, it is especially important that you discuss with the child's doctor the good that this medicine may do as well as the risks of using it.

Older adults--Certain side effects, such as confusion, swelling of the face, feet, or lower legs, or sudden decrease in the amount of urine, may be especially likely to occur in elderly patients, who are usually more sensitive than younger adults to the effects of nonsteroidal anti-inflammatory drugs. Also, elderly people are more likely than younger adults to get very sick if these medicines cause stomach problems. With phenylbutazone, blood problems may also be more likely to occur in the elderly.

Other medicines--Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking a nonsteroidal anti-inflammatory drug, it is especially important that your health care professional know if you are taking any of the following:

Other medical problems--The presence of other medical problems may affect the use of nonsteroidal anti-inflammatory drugs. Make sure you tell your doctor if you have any other medical problems, especially:


Proper Use of This Medicine

For patients taking a capsule, tablet (including caplet), or liquid form of this medicine:

For patients using a suppository form of this medicine:

For patients taking nonprescription (over-the-counter [OTC]) ibuprofen or naproxen :

For safe and effective use of this medicine, do not take more of it, do not take it more often, and do not take it for a longer time than ordered by your health care professional or directed on the nonprescription (over-the-counter [OTC]) package label . Taking too much of any of these medicines may increase the chance of unwanted effects, especially in elderly patients.

When used for severe or continuing arthritis, a nonsteroidal anti-inflammatory drug must be taken regularly as ordered by your doctor in order for it to help you. These medicines usually begin to work within one week, but in severe cases up to two weeks or even longer may pass before you begin to feel better. Also, several weeks may pass before you feel the full effects of the medicine.

For patients taking mefenamic acid :

For patients taking phenylbutazone :

Dosing--The dose of these medicines will be different for different patients. Follow your doctor's orders or the directions on the label . The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

The number of capsules or tablets or teaspoonfuls of suspension that you take, or the number of suppositories that you use, depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are taking the medicine .

People with arthritis usually need to take more of a nonsteroidal anti-inflammatory drug during a flare-up than they do between flare-ups of arthritis symptoms. Therefore, your dose may need to be increased or decreased as your condition changes.

Missed dose--If your health care professional has ordered you to take this medicine according to a regular schedule, and you miss a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. (For long-acting medicines or extended-release dosage forms that are only taken once or twice a day, take the missed dose only if you remember within an hour or two after the dose should have been taken. If you do not remember until later, skip the missed dose and go back to your regular dosing schedule.) Do not double doses.

Storage--To store this medicine:


Precautions While Using This Medicine

If you will be taking this medicine for a long time, as for arthritis (rheumatism), your doctor should check your progress at regular visits . Your doctor may want to do certain tests to find out if unwanted effects are occurring, especially if you are taking phenylbutazone. The tests are very important because serious side effects, including ulcers, bleeding, or blood problems, can occur without any warning.

Stomach problems may be more likely to occur if you drink alcoholic beverages while being treated with this medicine. Also, alcohol may add to the depressant side effects of phenylbutazone.

If you consume 3 or more alcoholic beverages per day, check with your doctor before taking this medicine.

Taking two or more of the nonsteroidal anti-inflammatory drugs together on a regular basis may increase the chance of unwanted effects. Also, taking acetaminophen, aspirin or other salicylates, or ketorolac (e.g., Toradol) regularly while you are taking a nonsteroidal anti-inflammatory drug may increase the chance of unwanted effects. The risk will depend on how much of each medicine you take every day, and on how long you take the medicines together. If your health care professional directs you to take these medicines together on a regular basis, follow his or her directions carefully. However, do not take acetaminophen or aspirin or other salicylates together with this medicine for more than a few days, and do not take any ketorolac (e.g., Toradol) while you are taking this medicine, unless your doctor has directed you to do so and is following your progress .

Before having any kind of surgery (including dental surgery), tell the medical doctor or dentist in charge that you are taking this medicine. If possible, this should be done when your surgery is first being planned. Some of the nonsteroidal anti-inflammatory drugs can increase the chance of bleeding during and after surgery. It may be necessary for you to stop treatment for a while, or to change to a different nonsteroidal anti-inflammatory drug that is less likely to cause bleeding.

This medicine may cause some people to become confused, drowsy, dizzy, lightheaded, or less alert than they are normally. It may also cause blurred vision or other vision problems in some people. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are confused, dizzy, or drowsy, or if you are not alert and able to see well . If these reactions are especially bothersome, check with your doctor.

For patients taking the buffered form of phenylbutazone (e.g., Alka-Butazolidin) :

For patients taking mefenamic acid :

Some people who take nonsteroidal anti-inflammatory drugs may become more sensitive to sunlight than they are normally. Exposure to sunlight, even for brief periods of time, may cause severe sunburn; blisters on the skin; skin rash, redness, itching, or discoloration; or vision changes. When you begin taking this medicine:

If you have a severe reaction from the sun, check with your doctor.

Serious side effects, including ulcers or bleeding, can occur during treatment with this medicine. Sometimes serious side effects can occur without any warning. However, possible warning signs often occur, including severe abdominal or stomach cramps, pain, or burning; black, tarry stools; severe, continuing nausea, heartburn, or indigestion; and/or vomiting of blood or material that looks like coffee grounds. Stop taking this medicine and check with your doctor immediately if you notice any of these warning signs .

Check with your doctor immediately if chills, fever, muscle aches or pains, or other influenza-like symptoms occur, especially if they occur shortly before, or together with, a skin rash . Very rarely, these effects may be the first signs of a serious reaction to this medicine.

Nonsteroidal anti-inflammatory drugs may cause a serious type of allergic reaction called anaphylaxis. Although this is rare, it may occur more often in patients who are allergic to aspirin or to any of the nonsteroidal anti-inflammatory drugs. Anaphylaxis requires immediate medical attention . The most serious signs of this reaction are very fast or irregular breathing, gasping for breath, wheezing, or fainting. Other signs may include changes in color of the skin of the face; very fast but irregular heartbeat or pulse; hive-like swellings on the skin; and puffiness or swellings of the eyelids or around the eyes. If these effects occur, get emergency help at once. Ask someone to drive you to the nearest hospital emergency room. If this is not possible, do not try to drive yourself. Call an ambulance, lie down, cover yourself to keep warm, and prop your feet higher than your head. Stay in that position until help arrives.

For patients taking ibuprofen or naproxen without a prescription:


Side Effects of This Medicine

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

Although not all of the side effects listed above have been reported for all of these medicines, they have been reported for at least one of them. However, since all anti-inflammatory analgesics are very similar, it is possible that any of the above side effects may occur with any of these medicines.

Some side effects may occur many days or weeks after you have stopped using phenylbutazone. During this time check with your doctor immediately if you notice any of the following side effects:

Sore throat and fever; ulcers, sores, or white spots in mouth; unusual bleeding or bruising; unusual tiredness or weakness

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.


Revised: 08/15/2000
Interim revision:
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Last updated: 24 January 2001