Strategies for minimizing NSAIDs side effects

9th June 2007 at 20:55 BST by Dr C.A.Jenner MB BS, FRCA. Permalink.

This article discusses the strategies to minimize the side-effects of NSAIDs.

Strategies for minimizing NSAIDs side effects

Introduction

Non-steroidal anti-inflammatory drugs (NSAIDs) are a class of drugs with analgesic, antipyretic and anti-inflammatory properties. These NSAIDs are mainly used for reducing pain, fever and inflammation.

There are three main categories of NSAIDs, including:

• salicylates
• traditional NSAIDs
• COX-2 selective inhibitors

The most commonly used traditional NSAIDs include:

• Aspirin
• Ibuprofen (Motrin, Advil, Motrin IB)
• Naproxen (Naprosyn, Aleve)
• Nabumetone (Relafen)

How do they work?

The NSAIDs work by hindering the main function of an enzyme. An enzyme is basically a protein that triggers changes in the body. Known as COX (cyclooxygenase), this enzyme has two forms, COX-1 and COX-2.

While COX-1 protects the stomach lining from harsh acids and digestive chemicals, it also helps in maintaining the kidney function. On the other hand, COX-2 is produced when the joints are injured or inflamed.

NSAIDs – Side Effects

The traditional NSAIDs tend to block the actions of both, COX-1 and COX-2. Therefore, the chances of stomach disorders and bleeding also increase considerably.

The side effects of NSAIDs can be divided into common, occasional and rare. Here we list the main amongst them.

1. Common side effects

   These are quite common and do not require medical intervention unless they become severe.

   • Indigestion
   • Heartburn
   • Nausea
   • Diarrhea
   • Sudden weight gain

2. Occasional

   • Ankle swelling
   • Headache
   • Dizziness
   • Vertigo
   • Tinnitus
   • Unusual bruising or bleeding
   • Skin rashes
   • Wheezing
   • Hives
   • High blood pressure

3. Rare

   Immediate medical help should be sought if any of these are witnessed.

   • Stomach cramps
   • Blood vomits
   • Bloody or black, tar-like stools

Strategies to minimize NSAID side effects

In this section, we discuss some of the main strategies to minimize the side effects of NSAIDs and enhance their therapeutic effect.

1. NSAIDs and gastrointestinal ulcers

   Patients with the following conditions are at a greater risk of developing NSAID-related gastrointestinal ulcers. Hence, the NSAIDs should be administered with proper precaution in these cases.

   • Advanced age (more than 75 years of age)
   • History of ulcers
   • Concurrent use of corticosteroids or anti-coagulants
   • Higher dosage of NSAIDs
   • Use of multiple NSAIDs
   • A serious underlying disease

   Experts suggest using gastro protective agents (such as acid suppressants like omeprazole, or prostaglandins analogues such as misoprostol) to reduce the risk of stomach problems. These agents mainly include high dose H2 blockers, proton-pump inhibitors and oral prostaglandin analogs.

2. Method of administration

   Both the timings and method of administering NSAIDs should be altered to minimize the negative impact of NSAIDs. You can make variations between taking the NSAIDs by injections, orally or through creams and gels.

   Ideally, it is advisable to follow the below:

   • Take oral NSAIDs with or after food or with milk to help minimize the stomach side effects.
   • Avoid alcohol to minimize the risk of stomach irritation
   • Have a lot of water and fluids when taking NSAIDs
   • Avoid high-caloric foods

3. Patient history

   Before an NSAID is administered, it is important to take into the consideration the relevant factors regarding the patient's health, medical history and other facts. The most important amongst these are:

   • Age
   • Alcohol
   • Tolerance levels
   • General health
   • Concurrent medication (steroids, anti-coagulants)

4. Follow the rules

   One of the most important factors is to follow the rules of medication. It is important to carefully read the label warnings and other dosage and administering instructions on the packaging. The packaging insert will also carry a detailed note on the possible side effects and consequences.

   Also, never take the NSAIDs beyond the prescribed quantity. Chemicals in these drugs can lead to serious consequences when taken in wrong quantities and can even prove fatal in some cases.

5. For children

   Infants above 6 months of age can be given a small dosage of ibuprofen in the liquid form. However, proper medical advice and the infant's condition needs to be taken into consideration.

6. Discontinuation

   Upon the occurrence of any of the serious side effects, immediately discontinue the medication and seek medical help.

Other Guidelines

• Use simple analgesics in place of NSAIDs, wherever possible
• Take only one NSAID at a time
• Opt for intra-articular corticosteroids, especially when the disease in localized
• Do not take NSAIDs if you are taking anti-coagulants or corticosteroids

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