NSAIDS - Nonsteroidal Anti-inflammatories

NSAIDS/Ibuprofen/Naproxyn - Uses, dosages and side-effects/contraindications

Nonsteroidal anti-inflammatories (NSAIDs) are a very popular class of drugs used primarily to treat various inflammatory conditions (as listed below). As indicated by the label, "NSAIDS" they are not steroids. In addition to decreasing inflammation, NSAIDs reduce pain, fever and, in many cases, help with wound healing. 

The most popular over-the-counter (OTC) medicines in this category include:

• Ibuprofen (Motrin, Advil) - An anti-inflammatory and analgesic (pain reliever)

Ibuprofen

• Naproxen (Aleve, Naprosyn) - An anti-inflammatory and pain reliever

• Aspirin (Bayer, Ecotrin, Bufferin) - analgesic (pain reliever), antipyretic (fever reducer), as well as an anti-clotting agent

• Diclofenac is another NSAID - or nonsteroidal anti-inflammatory - which is also becoming an increasingly popular anti-inflammatory and pain reliever. It comes in both oral and topical forms. It is generally considered a stronger anti-inflammatory - comparable to Meloxicam (see below). You need to get a prescription for this from your healthcare provider.

• Meloxicam (Mobic) is considered a better anti-inflammatory than ibuprofen and may have better tolerability as well. It does have some interactions, side effects and contraindications.  READ LABELS! By prescription only.

Acetaminophen/Tylenol is not in this category because it is not an anti-inflammatory.​

While most anti-inflammatories do the same thing and have the same primary side effects, the following information (below) focuses on Ibuprofen, the most commonly used anti-inflammatory on the market. In addition to providing pain relief, it is an excellent anti-inflammatory and fever reducer

HISTORY: Ibuprofen was developed in the 1960s. It was initially developed synthetically as a prescription drug. 

USES:  

General: Anti-inflammatory, fever reducer, pain reliever

Respiratory: Sore throat, ear aches

Musculoskeletal: Ibuprofen is primarily used for musculoskeletal aches and pains (like arthritis, orthopedic injuries and body aches)

Genitourinary: Menstrual cramps

Neurologic: Headaches

Other: Fever, decreased blood clotting time (except diclofenac)

Forms: Liquid, gel caps, tablets, caplets, topical, IV (Ibuprofen), patch (diclofenac), chewable (aspirin 81 mg)

Brand Names: Ibuprofen (Brand Names Advil and Motrin) is available in many multi-symptom cold and flu products. aspirin (Brand names: Bayer, Excedrin, Bufferin), naproxen (Brand name: Aleve), Diclofenac (Voltaren-topical)

Most over-the-counter cold and flu medications contain Ibuprofen or acetaminophen. If you take a multi-symptom medicine containing either of these, you will likely not need to take them in addition to your cold and flu medicine.

Note: Most generics of ibuprofen and naproxen are suitable replacements of the brand names and tend to be a lot less expensive.

​Usual Dosages of NSAIDs (Nonsteroidal Anti-inflammatories)

​Dosages usually depend on the condition you are treating

• Ibuprofen: The usual dose is 2-3 tablets (200-600 mg) 3 to 4 times daily (max dose 3200 mg/24 hours). It should be taken with food to prevent stomach problems. Healthcare providers can prescribe you 800 mg tabs if you temporarily need high dose.

• Aspirin: 81 mg - 325 mg (325 mg - 650 mg every 4-6 hours is the usual dose as an anti-inflammatory); (81mg  - 325 mg usual dose for the heart). Enteric coated is reputed to be safer on your gastrointestinal system.

• Naproxen: 250 mg-500 mg (every 12 hours)

• Diclofenac: The oral form is available by prescription only (delayed-release 25mg to 50 mg 2-4 times daily; extended-release 100 mg daily gels are available over the counter​.Certain diclofenac products are not interchangeable.

• Meloxicam: This is available by prescription only. Oral capsules are not interchangeable with other oral forms. Usual dose is 5-10 mg orally daily.

It is vital to begin analgesics, if you can, before the pain becomes severe: It is easier to control it in the beginning than trying to turn around when it is extreme.

I recommend starting low if possible and increasing the next dose if the initial dose is ineffective.

Note: Many of these are contraindicated in those with gastric ulcers, significantly high blood pressure and kidney disease. If you have any questions, discuss use with your healthcare provider.

Side Effects: These include stomach aches, ulcers, hypertension, cardiovascular events (especially with diclofenac and meloxicam), kidney disease (many of these are from long-term use), allergic reaction (hives, itching, rash, wheezing), and increased bleeding (Ibuprofen and naproxen have mild anti-clotting effects, aspirin has strong anti-clotting effects and can also increase asthma symptoms). So, if you have been using these for a long time, it may be time to look for an alternative. If you are on aspirin as an anti-clotting agent speak to the provider before changing or discontinuing.

Caution/Contraindications: Coronary bypass surgery, recent MI, congestive heart failure, gastrointestinal bleeding, capsules, ulcers, kidney disease, older people, and those already on blood thinners (will increase the risk of bleeding even more). 

DO NOT EXCEED RECOMMENDED DOSES WITHOUT DISCUSSING WITH YOUR HEALTHCARE PROVIDER