NSAIDs

NSAIDs: Overview

NSAIDs are medications for arthritis and other painful inflammatory conditions in the body.  Aspirin, ibuprofen (Motrin), naproxen (Naprosyn), and etodolac (Lodine) are a few examples of this class of medication.

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Why it is Recommended

If you are taking them already and tolerating them well, the reduced risk of Alzheimer's disease may be another very motivating reason to continue.

Instructions

The chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs) should be restricted to those conditions that have not responded to more natural means or methods.  Always deal with the underlying causes when known or possible and consider using the lowest possible dose to accomplish the job.

Side-Effects

Side-effects vary among different NSAIDs with some being safer than others.

NSAIDs can help with the following:

Aging

Alzheimer's Disease

At least twenty studies suggest that Ibuprofen and other NSAIDs – common non-prescription drugs – may slow or prevent the onset of Alzheimer's disease by as much as 60%.  Researchers say it also opens up a new way to think about how Ibuprofen protects the brain.

"We've shown that a drug that's available, that's been in use for 30 to 40 years, and for which we know the side-effect profiles... can reduce both the inflammatory response to amyloid and the amyloid itself", says study leader Gregory M.  Cole of the University of California in Los Angeles.

Note that NSAIDs can cause serious stomach problems, including bleeding.  Investigators therefore hesitate to recommend widespread use of the drugs until they can develop safer versions.

Certain NSAIDs work by decreasing the levels of amyloid-beta 42 rather than by inhibiting cyclooxygenase, as was once proposed.  Advil (Ibuprofen) is the most effective, requiring as little as 800mg per day to reduce the risk of Alzheimer's without serious side-effects.  Other NSAIDs require much higher doses to achieve this benefit, while aspirin, Naproxen and celeloxib (Celebrex) were found ineffective.

Not recommended for
Parkinson's Disease

Naproxen and other NSAIDs may exacerbate Parkinson's disease.

Digestion

Not recommended for
Not recommended for
Gastric/Peptic/Duodenal Ulcers

Prostaglandins are substances that are important in helping the gut linings resist corrosive acid damage.  NSAIDs cause ulcers by interfering with prostaglandins in the stomach.

Inflammation

Chronic Inflammation

Although they are sometimes necessary, long-term use of the more dangerous antiinflammatory drugs, such as prednisone, can cause diabetes, osteoporosis, or even death.

Musculo-Skeletal

Polymyalgia Rheumatica

An initial daily regimen of low-dose prednisone (6 to 10mg) or nonsteroidal agents may control morning stiffness and pain.  In the absence of ocular symptoms, PMR can be treated with maximal doses of NSAIDs.  Prednisone (10 to 15mg daily) will give a more prompt therapeutic response, but the toxicity from long-term use at dosages greater than 7.5 mg/day is high.  Usually, low-dosage maintenance can be achieved within weeks.  Reassessment is mandatory if ocular or other symptoms develop; in such cases, the steroid dosage must be increased.  Some patients require a low dosage of steroids for life; others may be weaned from steroids after two to four years.

Gout / Hyperuricemia

Medications such as Nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids and allopurinol are commonly used against gout.  The NSAID that is most widely used to treat acute gout is indomethacin.  NSAIDs may also have significant toxicity, but if used for the short-term, are generally well tolerated.

NSAIDs are the treatment of choice for acute attacks of gout in most patients.  NSAIDs should be used sparingly in elderly patients and should be avoided in patients with renal disease and peptic ulcer disease, and in those receiving concurrent systemic anticoagulation.  Corticosteroids are a valuable treatment option for patients in whom NSAID therapy is contraindicated.  Acute gouty arthritis and chronic gout require different treatment strategies.

Juvenile Rheumatoid Arthritis

Indomethacin is frequently more effective than aspirin in treating individuals with pauciarticular arthritis of the lower extremities and ankylosing spondylitis.  The recommended dose is 1.5-3mg/kg/day and should not exceed 250mg/day.

Costochronditis

Nonsteroidal anti-inflammatory medications (e.g. Motrin, Advil) help decrease the pain and the inflammation, which is the primary problem.  Check with your doctor before taking NSAIDs as they have potential side-effects.

Osteoarthritis

NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are commonly used to treat osteoarthritis.  Available over the counter or by prescription, they fight inflammation or swelling and relieve pain.  Acetaminophen such as Tylenol can also be very effective in treating the pain.  Research has shown that in many patients acetaminophen relieves pain as effectively as NSAIDs.  These pain killers will only help control the symptoms, and if used at all should only be used for pain control while more effective therapies are at work.  The newer COX2 inhibitors will have fewer side effects, but still do not restore normal function.  Topical pain-relieving creams, rubs and sprays can be applied directly to the skin.  There are many brands available over the counter.

Compartment Syndrome

NSAIDs may be effective, but are generally believed to have questionable usefulness.

Organ Health

Not recommended for
Cirrhosis of the Liver

Certain medications are potentially hepatotoxic (can damage the liver) and should be used with caution in patients with chronic liver disease.  In general, NSAIDs should be avoided; acetaminophen at under 2gm per day is the safest choice.

Pain

Low Back Pain

Use pain medication, if necessary, such as Tylenol, Aleve or another NSAID, such as aspirin.

Reproductive

Painful Menstruation (Dysmenorrhea)

Anti-inflammatories such as Motrin, while useful for the management of acute pain, do little to deal with any underlying causes.

Tumors, Benign

Colon Polyps

Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) could act to prevent the development of polyps in the colon, which are precursors to most colorectal cancers.  In one study, patients who took aspirin or other NSAIDs more than 15 times per month at some time during the five years prior to the study were defined as "regular users"; patients who never took medication more than 15 times per month were defined as "non-users".  After accounting for factors such as diet, lifestyle and family medical history, Dr. Sandler found that regular users of aspirin and other NSAIDs were only half as likely to harbor colon polyps as non-users.

"Our study supports the idea that some mechanism in aspirin and other NSAIDs has a protective effect when it comes to colon cancer," said Dr. Sandler.  "More significantly, our results indicate that this protective effect occurs early in the process of cancer development, helping us to pinpoint where in the cancer development sequence these drugs might work best." [ Gastroenterology, March 1998]

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NSAIDs can help prevent the following:

Tumors, Malignant

Colon Cancer

Aspirin and other NSAIDs have been previously reported to protect against the development of colorectal cancer.  [Gastroenterology, March 1998]

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KEY

May be useful: may help with
May be useful:
may help with
Moderately useful: often helps with; often prevents
Moderately useful:
often helps with; often prevents
Very useful: is highly recommended for
Very useful:
is highly recommended for
Often counterindicated: is often not recommended for
Often counterindicated:
is often not recommended for
Should be avoided: is NOT recommended for
Should be avoided:
is NOT recommended for