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See more conditions. Request Appointment. Products and services. Answer From Rekha Mankad, M. Thank you for Subscribing Our Housecall e-newsletter will keep you up-to-date on the latest health information. Please try again. Something went wrong on our side, please try again. S Food and Drug Administration. NSAIDs decrease the production of prostaglandins [a group of compounds that transmit messages between cells] from a component of cells called arachadonic acid by inhibiting the enzyme cyclooxygenase.
Certain of these prostaglandins play a role in inflammation and the generation of pain in conditions such as rheumatoid arthritis. However, cyclooxygenase also produces other prostaglandins that protect the lining of the stomach and duodenum against injury, notably peptic ulcer disease. At the same time most enzymes produce thromboxane, a chemical which assists in blood clotting hemostasis. Thus, administration of NSAIDs has the undesirable side effect of causing erosions or ulcers in the upper gut, and interfering with blood clotting when they bleed.
While the anti-clotting effect of aspirin is put to good use preventing unwanted clotting in the vessels of the brain, heart, and legs, these effects are potentially dangerous. The disadvantages of traditional NSAIDs have stimulated research into measures to counteract them while maintaining their usefulness.
Depending upon the painful disorder being treated, these risks may be acceptable if the benefit is sufficiently satisfactory. As could be predicted from the gut and blood clotting effects cited above, NSAIDs cause gastric and duodenal ulcers and sometimes life-threatening intestinal bleeding.
Such events require cessation of the drug, endoscopy to confirm the ulcer and, if necessary, control the bleeding, antiulcer therapy with proton pump inhibitors, and occasionally emergency surgery. The risk is greatest in older females, and other risk factors are listed in Table 2.
Sometimes an ulcer develops without abdominal pain dyspepsia and bleeding may be the first manifestation. Learn more about functional dyspepsia. Because of the anti-platelet anti-clotting effects of most NSAIDs, they must be stopped one week before surgical or dental procedures, and bleeding from an injury may be more difficult to control.
Data exposed a risk of thromboembolic complications in those taking rofecoxib Vioxx and in the drug was withdrawn from the U. Acetaminophen Tylenol is a pain killer without the anti-inflammatory component, and is a better choice if pain relief is the only objective. In osteoarthritis, exercises developed with advice from your doctor, perhaps with the help of a physiotherapist, may help avoid the need for drugs. The risk also increases with the duration of treatment, the dose, concomitant use of other NSAIDs or steroids, and the presence of debilitating disease.
A history of previous ulcer may also be a warning. Use the Lowest Effective Dose — From the foregoing, it is obvious that one should employ the lowest dose of the drug that is effective, and only for as long as is necessary. Ibuprofen, diclofenac, and naproxen are said to be among the safest. However, reports conflict, and it is difficult to know the risks in relation to efficacy.
A safer drug could imply a weaker drug. Treat or Prevent Ulcers — There have been attempts to use a variety of anti-ulcer drugs along with the NSAIDs to prevent gut damage, especially in high-risk patients. H2 blocking drugs e. Misoprostol has been combined with diclofenac Arthrotec and shown to reduce the gut complications. More recently, omeprazole has been shown to be superior to misoprostol for this purpose. You might call them pain relievers. You might take them for back pain, headache, or arthritis.
Whatever you call them and for whatever reason you take them, NSAIDs are among the most popular medications worldwide. Along with sporadic users, more than 30 billion doses are taken each year. At the top of the list are digestive problems including stomach upset, heartburn, and ulcers. Why they work 7 side effects Ask a doctor if When to consult a doctor or pharmacist.
Long-term use side effects. Additional factors. Drug interactions. The takeaway. Read this next. Ibuprofen vs. Acetaminophen: How Are They Different? Medically reviewed by Lindsay Slowiczek, PharmD. Is It Possible to Overdose on Ibuprofen? Medically reviewed by Stacy Sampson, D. Pain relief basics. Medically reviewed by Timothy J. Legg, Ph.
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