NSAIDs Nonsteroidal Anti-Inflammatory Drugs
NSAIDs fall into three basic catgories – traditional NSAIDs, COX-2 inhibitors and salicylates. All NSAIDs work by blocking prostaglandins, hormone-like substances that contribute to pain, inflammation, fever and muscle cramps. However, not all NSAIDs are alike.
Traditional NSAIDs
Traditional NSAIDs make up the largest group of drugs in this class, featuring some 20 prescription medications – three of which are available in lower-strength, non-prescription doses. Like all medications, NSAIDs, even the over-the-counter versions, carry a risk of side effects, including stomach upset and gastrointestinal bleeding. For that reason, it's important to consult your doctor before taking any medication you buy without a prescription.
COX-2 Inhibitors
COX-2 inhibitors help reduce pain and inflammation like traditional NSAIDs but are designed to be safer for the stomach. (See "Spare Your Stomach") Digestive tract studies have shown less stomach damage from the COX-2 drugs compared to traditional NSAIDs; however, COX-2s have not been used as long as NSAIDs. Studies to determine the incidence of side effects and safety continue. In fact, in a high-profile move at the end of last year, one COX-2, rofecoxib (Vioxx), was withdrawn from the market after several large studies showed an increased cardiovascular risk after 18 months of use. (See "Life After Vioxx") Long-term studies to evaluate the cardiovascular risks of the other two COX-2 drugs are underway.
Salicylates
The original category of NSAIDs – the salicylates (SUH-lis-UH-lates) – includes aspirin and is still preferred by many patients and doctors. If you plan to take aspirin for more than occasional aches and pains, consult your doctor. Frequent large doses, which can cause some serious side effects, usually are needed to control arthritis pain and inflammation. Your doctor can work with you to determine the best dosage and help you prevent or manage side effects, including kidney problems and gastrointestinal bleeding.
Your doctor may prescribe a chemical variation referred to as a nonacetylated salicylate, which is specially formulated to have fewer side effects, if aspirin is too risky for you. Unfortunately, nonacetylated salicylates lack aspirin's beneficial protection against cardiovascular disease. Therefore, if you've been advised to take low-dose ("baby") aspirin to prevent a heart attack or stroke and your doctor prescribes a nonacetylated salicylate – or any other NSAID, for that matter – ask about continuing your low-dose aspirin along with it.
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