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NSAIDs: Side Effects and Solutions

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All medicines, including nonsteroidal anti-inflammatory drugs (NSAIDs) come with plusses and minuses, as described in NSAIDs: Benefits and Risks. Side effects are more likely to happen if you take large doses of NSAIDs or if you take them for a long time. Some side effects are mild and will go away on their own, but others are more serious and need medical attention. Some bad effects can be reduced or avoided by taking the medicine in a certain way or by adding other drugs or supplements or by making healthy lifestyle choices.

Here are some common unwanted effects of NSAIDs, and ways you can help ease them.

Stomach Problems

NSAIDs can cause nausea, heart burn, vomiting, gas, belly pain, diarrhea or constipation. More serious stomach problems include ulcers and bleeding in the gastrointestinal tract.  If you have a history of ulcers, your doctor will probably find a different way to control your pain and inflammation. Call your doctor right away if you have severe abdominal pain, a black, tarry bowel movement or see any blood in your stool.

Stomach discomfort caused by NSAID use can usually be avoided by taking each dose after a full meal or with an antacid like Tums, Maalox or Mylanta.

Other drugs that can help protect your stomach include misoprostol (Cytotec), omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (Protonix), lansoprazole (Prevacid), and rabeprazole (Aciphex). These drugs can greatly reduce your risk of developing an ulcer or internal bleeding.

Another option if you develop tummy problems is to switch to the COX-2 selective inhibitor celecoxib (Celebrex). This drug has a lower risk of causing stomach problems than other NSAIDs.

Don’t drink alcohol when using NSAIDs. It increases your risk of internal bleeding.

Be careful of combining medicines. Taking corticosteroids or blood thinners such as warfarin (Coumadin) with NSAIDs can increase your risk of gastrointestinal bleeding. You can also cause problems if you take your prescription NSAID and then unwittingly take another medicine, such as an OTC cold remedy, that also contains an NSAID. Check with your pharmacist before adding any drug or dietary supplement to your treatment.

Cardiovascular Problems

All NSAIDs other than aspirin can increase your chance of having high blood pressure, heart attack or stroke. The FDA warns that these serious side effects can occur as early as the first few weeks of using an NSAID, and the risk can rise the longer you take the drugs.

People who already have cardiovascular disease -- particularly those who have had a heart attack or cardiac bypass surgery -- are at the greatest risk for heart attack or stroke associated with NSAIDs.

The best thing you can do to prevent heart problems due to NSAID use is to reduce your other risk factors. Smoking, high blood pressure, high cholesterol and diabetes are significant risk factors for heart disease. Commit yourself to taking care of all aspects of your health.

If you take medicine for high blood pressure, have your pressure checked regularly while taking NSAIDs.

If you take low-dose aspirin to prevent heart attack and stroke, some NSAIDs, including ibuprofen and naproxen, can interfere with that protective effect. So be sure to discuss NSAID choice with your doctor. And only use the medicine as directed. Take the lowest effective dose for the shortest amount of time possible. And make sure you aren’t getting NSAIDs from multiple sources, like from cold medicines on top of your prescription.

Allergic Reaction

You could be allergic to any medicine, including NSAIDs. Allergic reactions can range from mild rashes to anaphylactic shock. Just because you can take one NSAID without reaction, doesn’t necessarily mean that all of them are safe for you. Each new drug you take carries a risk of allergic reaction.

Be aware of allergic symptoms, like rash, hives, facial swelling, wheezing and difficulty breathing . If you have a mild reaction, antihistamines like diphenhydramine (Benadryl) will ease the symptoms until the medicine works its way out of your system. If you have a serious reaction, like throat swelling or breathing difficulty, call 911 immediately.

Kidney Problems

Fluid retention (swollen ankles and feet) is the most common NSAID-related kidney problem. Rarely, high-dose, long-term use of NSAIDs can cause chronic kidney disease known as chronic interstitial nephritis in some people. If your urine is cloudy, if you start urinating less frequently than usual, or if you notice swelling in your ankles and feet, stop taking your NSAID and call your doctor.

Simple blood and urine tests are used to test your kidney function. NSAID-related kidney problems are reversible once you stop taking these medicines. 

If you know you have kidney disease, check with your doctor before you take any NSAID, including over-the-counter ones.

Bruising and Bleeding

Because NSAIDs reduce your blood’s ability to clot, you may bruise more easily and you may find that cuts are slower to stop bleeding. Bleeding problems can be serious if you take NSAIDs on top of blood thinners like warfarin (Coumadin). Certain herbal supplements, including willow bark, are also known to thin the blood or prevent clotting, so you must be careful about taking them together with NSAIDs. Be certain to check with your doctor or pharmacist before taking any new medication or supplement to be certain they don’t interact and cause damage.

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