{"id":1462,"date":"2023-12-10T20:38:01","date_gmt":"2023-12-10T20:38:01","guid":{"rendered":"https:\/\/www.bidrx.com\/blog\/?p=1462"},"modified":"2023-12-10T20:41:40","modified_gmt":"2023-12-10T20:41:40","slug":"guide-to-nsaids","status":"publish","type":"post","link":"https:\/\/www.bidrx.com\/blog\/headache-medications\/guide-to-nsaids\/","title":{"rendered":"Reference Guide to Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)"},"content":{"rendered":"<p><b>Highlights<\/b><\/p>\n<ul>\n<li aria-level=\"1\"><b>NSAIDs are among the most commonly used medications to relieve mild to moderate pain from inflammation associated with conditions like arthritis, headaches, injuries and menstrual cramps.<\/b><\/li>\n<\/ul>\n<ul>\n<li aria-level=\"1\"><b>They work by blocking enzymes called cyclooxygenase (COX) that participate in the production of inflammatory compounds.\u00a0<\/b><\/li>\n<\/ul>\n<ul>\n<li aria-level=\"1\"><b>NSAIDs can help relieve swelling, pain and fever, but may also cause side effects like stomach bleeding and ulcers, kidney problems, ringing in the ears, dizziness and increased heart risks.<\/b><\/li>\n<\/ul>\n<ul>\n<li aria-level=\"1\"><b>There are two main types of NSAIDs: selective and nonselective.<\/b><\/li>\n<\/ul>\n<ul>\n<li aria-level=\"1\"><b>NSAIDs interact with several medications, including blood thinners, steroids, diuretics and ACE inhibitors. Use caution when combining NSAIDs with other drugs.<\/b><\/li>\n<\/ul>\n<hr \/>\n<p><span style=\"font-weight: 400;\">Nonsteroidal anti-inflammatory drugs (NSAIDs) are a class of medications widely used for their pain-relieving, fever-reducing, and, as the name suggests, anti-inflammatory properties. Common examples of NSAIDs include aspirin, ibuprofen (Motrin and Advil), and naproxen (Aleve).\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">NSAIDs are an important part of the treatment of pain, targeting the enzymes that jump-start the process of inflammation. They\u2019re often used to treat conditions like arthritis, menstrual cramps, and various forms of acute pain.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">But the devil is in the details. While they\u2019re very effective, NSAIDs can cause a wide range of side effects and drug interactions. This is why it\u2019s important to know the type of NSAID you\u2019re using and the potential benefits and risks of each.\u00a0<\/span><\/p>\n<h2>How NSAIDs Work<\/h2>\n<p><img decoding=\"async\" class=\"aligncenter wp-image-1464\" src=\"https:\/\/www.bidrx.com\/blog\/wp-content\/uploads\/2023\/12\/2.jpeg-3.jpg\" alt=\"Cellular representation of How NSAIDs Work\" width=\"780\" height=\"515\" \/><\/p>\n<p><span style=\"font-weight: 400;\">When an injury or infection occurs in the body, it triggers the release of chemicals that initiate the body\u2019s natural healing response. As part of this process, cyclooxygenase (COX) enzymes are activated. Their job is to produce prostaglandins, which are essential to the healing process but cause inflammation, pain, and fever.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">NSAIDs work by blocking the COX enzymes to reduce the amount of prostaglandins they produce.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">There are two main COX enzymes:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>COX-1. <\/b><span style=\"font-weight: 400;\">COX-1 is always active in your body, taking care of everyday functions, like protecting your stomach lining.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>COX-2. <\/b><span style=\"font-weight: 400;\">COX-2 is a specialist called in for specific tasks, like dealing with pain and inflammation from injuries.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">NSAIDs differ in how they affect COX-1 and COX-2. Non-selective (traditional) NSAIDs, like <\/span><b>ibuprofen<\/b><span style=\"font-weight: 400;\"> and <\/span><b>naproxen,<\/b><span style=\"font-weight: 400;\"> block both, while selective COX-2 inhibitors (like <\/span><b>celecoxib<\/b><span style=\"font-weight: 400;\">) primarily block just COX-2. The challenge is to reduce the prostaglandins that cause pain and inflammation, while trying not to limit the effect on prostaglandins that have protective roles.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The selectivity of NSAIDs can make a difference in the side effects and suitability of an NSAID for different individuals. Here\u2019s a rundown of the types and subtypes of NSAIDs.<\/span><\/p>\n<h2>Non-Selective (Traditional) NSAIDs<\/h2>\n<p><img decoding=\"async\" class=\"aligncenter wp-image-1465\" src=\"https:\/\/www.bidrx.com\/blog\/wp-content\/uploads\/2023\/12\/3.jpeg-4.jpg\" alt=\"naproxen molecule\" width=\"780\" height=\"520\" \/><\/p>\n<p><span style=\"font-weight: 400;\">Non-selective NSAIDs work by blocking both the COX-1 and COX-2 enzymes involved in mediating inflammation and pain. Most over-the-counter pain relievers, like <\/span><b>ibuprofen<\/b><span style=\"font-weight: 400;\"> (Advil and Motrin) and <\/span><b>naproxen<\/b><span style=\"font-weight: 400;\"> (Aleve) are nonselective.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Nonselective NSAIDs can be categorized based on their chemical structure and subtype. Each subtype has its unique characteristics, although they all generally function by inhibiting both COX-1 and COX-2 enzymes.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Here&#8217;s an overview of the nonselective NSAID subtypes with examples:<\/span><\/p>\n<h3>Salicylates<\/h3>\n<p><span style=\"font-weight: 400;\">Salicylates are a class of NSAIDs derived from salicylic acid, a compound found naturally in plants.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Examples include:<\/span><\/p>\n<ul>\n<li><b>Aspirin <\/b><span style=\"font-weight: 400;\">(acetylsalicylic acid)<\/span><b>. <\/b><span style=\"font-weight: 400;\">The first NSAID to be developed, aspirin is still commonly used for inflammation, pain, fever, and to prevent blood clots.\u00a0<\/span><\/li>\n<li><a href=\"https:\/\/www.drugs.com\/mtm\/diflunisal.html\"><b>Diflunisal<\/b><\/a><span style=\"font-weight: 400;\"> (Dolobid)<\/span><b>.<\/b><span style=\"font-weight: 400;\"> Primarily used to relieve pain.<\/span><\/li>\n<li><a href=\"https:\/\/www.drugs.com\/cdi\/methyl-salicylate.html\"><b>Methyl salicylate<\/b><\/a> <span style=\"font-weight: 400;\">(Ben Gay, IcyHot, Salonpas)<\/span><b>.<\/b><span style=\"font-weight: 400;\"> Often found in topical pain relief products, such as creams and ointments, used for relieving muscle and joint pain.<\/span><\/li>\n<li><a href=\"https:\/\/www.drugs.com\/mtm\/bismuth-subsalicylate.html\"><b>Bismuth salicylate<\/b><\/a> <span style=\"font-weight: 400;\">(Pepto Bismol, Kaopectate)<\/span><b>. <\/b><span style=\"font-weight: 400;\">Commonly used to treat nausea, heartburn, indigestion, upset stomach, and diarrhea.<\/span><\/li>\n<li style=\"list-style-type: none;\"><\/li>\n<\/ul>\n<h3>Propionic Acid Derivatives<\/h3>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Ibuprofen. <\/b><span style=\"font-weight: 400;\">Widely used for pain, inflammation, and fever.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Naproxen.<\/b><span style=\"font-weight: 400;\"> Longer acting, used for similar indications as ibuprofen.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.drugs.com\/mtm\/ketoprofen.html\"><b>Ketoprofen<\/b><\/a><span style=\"font-weight: 400;\"> (Orudis, Oravail)<\/span><b>.<\/b><span style=\"font-weight: 400;\"> Used for pain, inflammation, and fever.<\/span><\/li>\n<\/ul>\n<p><img decoding=\"async\" class=\"aligncenter wp-image-1466\" src=\"https:\/\/www.bidrx.com\/blog\/wp-content\/uploads\/2023\/12\/4.jpeg-5.jpg\" alt=\"red cells\" width=\"780\" height=\"515\" \/><\/p>\n<h3>Acetic Acid Derivatives<\/h3>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.bidrx.com\/home\/medicine_details\/indomethacin-20-mg-capsule\"><b>Indomethacin<\/b><\/a> <span style=\"font-weight: 400;\">(Indocin, Tivorbex)<\/span><b>.<\/b><span style=\"font-weight: 400;\"> A potent NSAID often used for treating gout, arthritis, and other inflammatory conditions.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.bidrx.com\/home\/medicine_details\/diclofenac-sod-25-mg-tab-ec\"><b>Diclofenac<\/b><\/a><b> (<\/b><span style=\"font-weight: 400;\">Voltaren, Cataflam, Zipsor)<\/span><b>.<\/b><span style=\"font-weight: 400;\"> Commonly used for arthritis-related inflammatory pains.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.drugs.com\/pro\/ketorolac.html\"><b>Ketorolac<\/b><\/a> <span style=\"font-weight: 400;\">(Toradol)<\/span><b>.<\/b><span style=\"font-weight: 400;\"> Often used for short-term management of moderate to severe pain, especially following surgery.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.drugs.com\/mtm\/sulindac.html\"><b>Sulindac<\/b><\/a> <span style=\"font-weight: 400;\">(Clinoril)<\/span><b>. <\/b><span style=\"font-weight: 400;\">Less commonly used, but effective for certain types of pain and inflammation.<\/span><\/li>\n<\/ul>\n<h3>Enolic Acid (Oxicams)<\/h3>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.drugs.com\/mtm\/piroxicam.html\"><b>Piroxicam<\/b><\/a> <span style=\"font-weight: 400;\">(Feldene)<\/span><b>. <\/b><span style=\"font-weight: 400;\">Used for chronic inflammatory conditions because of its long half-life.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.bidrx.com\/home\/medicine_details\/meloxicam-10-mg-capsule\"><b>Meloxicam<\/b><\/a> <span style=\"font-weight: 400;\">(Mobic, Vivlodex)<\/span><b>.<\/b><span style=\"font-weight: 400;\"> Slightly more COX-2 selective but still considered nonselective; used for osteoarthritis and rheumatoid arthritis.<\/span><\/li>\n<\/ul>\n<h3>Fenamates<\/h3>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.drugs.com\/mtm\/mefenamic-acid.html\"><b>Mefenamic acid<\/b><\/a><span style=\"font-weight: 400;\"> (Ponstel)<\/span><b>.<\/b><span style=\"font-weight: 400;\"> Often used for short-term pain management, such as for menstrual pain.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.drugs.com\/mtm\/meclofenamate.html\"><b>Meclofenamate<\/b><\/a> <span style=\"font-weight: 400;\">(Meclomen)<\/span><b>. <\/b><span style=\"font-weight: 400;\">Used for various types of arthritis.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">While several of these medications are available over the counter, such as aspirin, ibuprofen, naproxen, and diclofenac, most are available by prescription only.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Prescription NSAIDs are used for more severe pain or conditions that over-the-counter NSAIDs may not effectively manage. It&#8217;s important to use them under the guidance of a healthcare professional due to the potential for side effects and interactions with other medications.<\/span><\/p>\n<p><img decoding=\"async\" class=\"aligncenter wp-image-1467\" src=\"https:\/\/www.bidrx.com\/blog\/wp-content\/uploads\/2023\/12\/5.jpeg-1.jpg\" alt=\"elderly customer talking with pharmacist\" width=\"780\" height=\"520\" \/><\/p>\n<h3>Warnings and Contraindications \u2014 Non-Selective NSAIDs<\/h3>\n<p><span style=\"font-weight: 400;\">As non-selective NSAIDs inhibit both COX pathways including the protective COX-1 enzyme, they carry more gastrointestinal, renal, and cardiovascular cautions and contraindications compared to selective NSAIDs.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The specific warnings for non-selective NSAIDs include:\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Gastrointestinal risks: <\/b><span style=\"font-weight: 400;\">There is an increased risk of developing gastrointestinal ulcers and bleeding with the use of non-selective NSAIDs. This is due to their inhibitory effect on the COX-1 enzyme, which normally helps to protect the lining of the stomach.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Impaired kidney function. <\/b><span style=\"font-weight: 400;\">These drugs can impair kidney function. The inhibition of COX enzymes can reduce blood flow to the kidneys, which may lead to kidney damage, especially in individuals with pre-existing renal impairment or those using other drugs that can be toxic to the kidneys.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Cardiovascular concerns. <\/b><span style=\"font-weight: 400;\">Prolonged use of non-selective NSAIDs is associated with an increased risk of heart problems and stroke. This risk may be higher in individuals with existing cardiovascular diseases.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Asthma and aspirin sensitivity. <\/b><span style=\"font-weight: 400;\">Non-selective NSAIDs are not recommended for use in individuals who are asthmatic or have a known sensitivity to aspirin. These drugs can exacerbate asthma symptoms and may trigger severe allergic reactions in aspirin-sensitive patients.<\/span><\/li>\n<\/ul>\n<h3>Side Effects \u2014 Non-Selective NSAIDs<\/h3>\n<p><span style=\"font-weight: 400;\">Nonselective NSAIDs, which inhibit both COX-1 and COX-2 enzymes, can cause a range of side effects. Here are some of the common ones:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Stomach pain<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Heartburn<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Nausea<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Gastric ulcers<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Kidney impairment<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Heart attack\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Stroke<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Hypertension (high blood pressure)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Allergic reactions<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Dizziness\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Headaches<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Liver damage<\/span><\/li>\n<\/ul>\n<h3>Drug Interactions \u2014 Non-Selective NSAIDs<\/h3>\n<p><img decoding=\"async\" class=\"aligncenter wp-image-1468\" src=\"https:\/\/www.bidrx.com\/blog\/wp-content\/uploads\/2023\/12\/6.jpeg-1.jpg\" alt=\"pharmacist holding a blister pack\" width=\"780\" height=\"520\" \/><\/p>\n<p><span style=\"font-weight: 400;\">Potential drug interactions for all nonselective NSAIDs are very similar, though there is some variation among specific drugs in this category. Visit the Drugs.com <\/span><a href=\"https:\/\/www.drugs.com\/drug_interactions.html\"><span style=\"font-weight: 400;\">Drug Interaction Checker<\/span><\/a><span style=\"font-weight: 400;\"> for an accurate list of interactions for your specific medication.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The interactions on this list are also very similar to those given above for selective NSAIDs, with a couple of additions.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Here are the most common drug interactions for nonselective (traditional) NSAIDs:<\/span><\/p>\n<ul>\n<li><b>Anticoagulants. <\/b><span style=\"font-weight: 400;\">Selective COX-2 inhibitors may increase the risk of bleeding when combined with anticoagulant medications such as <\/span><b>warfarin<\/b><span style=\"font-weight: 400;\"> or <\/span><b>heparin<\/b><span style=\"font-weight: 400;\">.<\/span><\/li>\n<li aria-level=\"1\"><b>Aspirin. <\/b><span style=\"font-weight: 400;\">COX-2 inhibitors can diminish the antiplatelet action of aspirin, increasing the risk of blood clots or stroke.<\/span><\/li>\n<li aria-level=\"1\"><b>Antihypertensive medications. <\/b><span style=\"font-weight: 400;\">The use of selective COX-2 NSAIDs with any of the following can reduce the effectiveness of the blood pressure medication:<br \/>\n<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">ACE inhibitors like <\/span><b>lisinopril<\/b><span style=\"font-weight: 400;\">\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Beta blockers, like <\/span><b>metoprolol<\/b><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Angiotensin II receptor blockers (ARBs), like <\/span><b>losartan<\/b><\/li>\n<\/ul>\n<\/li>\n<li aria-level=\"1\"><b>Diuretics. <\/b><span style=\"font-weight: 400;\">Taking these NSAIDs with thiazide diuretics, such as <\/span><b>furosemide,<\/b><span style=\"font-weight: 400;\"> or loop diuretics, like <\/span><b>hydrochlorothiazide<\/b><span style=\"font-weight: 400;\">, can reduce the effectiveness of the diuretic.<\/span><\/li>\n<li aria-level=\"1\"><b>Selective serotonin reuptake inhibitors (SSRIs). <\/b><span style=\"font-weight: 400;\">Taking SSRIs, such as <\/span><b>fluoxetine<\/b><span style=\"font-weight: 400;\"> or <\/span><b>sertraline<\/b><span style=\"font-weight: 400;\">, with COX-2 inhibitors can increase the risk of GI bleeding.<\/span><\/li>\n<li aria-level=\"1\"><b>Lithium. <\/b><span style=\"font-weight: 400;\">COX-2 inhibitors can cause increased lithium levels in the blood, which can lead to toxicity.<\/span><\/li>\n<li aria-level=\"1\"><b>Methotrexate. <\/b><span style=\"font-weight: 400;\">COX-2 inhibitors can cause increased methotrexate levels in the blood, which can lead to toxicity.<\/span><\/li>\n<li aria-level=\"1\"><b>Corticosteroids. <\/b><span style=\"font-weight: 400;\">When combined with COX-2 inhibitors, corticosteroids like <\/span><b>prednisone<\/b><span style=\"font-weight: 400;\"> can cause GI bleeding or ulcers.<\/span><\/li>\n<li aria-level=\"1\"><b>Cyclosporine and tacrolimus. <\/b><span style=\"font-weight: 400;\">Taking selective COX-2 NSAIDs together with the immunosuppressants <\/span><b>cyclosporine<\/b><span style=\"font-weight: 400;\"> or <\/span><b>tacrolimus<\/b><span style=\"font-weight: 400;\"> carries an increased chance of kidney toxicity.<\/span><\/li>\n<li aria-level=\"1\"><b>Other NSAIDs. <\/b><span style=\"font-weight: 400;\">NSAIDs taken with other NSAIDs can cause an increased risk of side effects.<\/span><\/li>\n<li aria-level=\"1\"><b>Digoxin. <\/b><span style=\"font-weight: 400;\">When used concurrently, selective COX-2 NSAIDs can impair digoxin clearance leading to increased blood levels of the drug.<\/span><\/li>\n<li aria-level=\"1\"><b>Antacids. <\/b><span style=\"font-weight: 400;\">Antacids containing <\/span><b>aluminum<\/b><span style=\"font-weight: 400;\"> or <\/span><b>magnesium hydroxide<\/b><span style=\"font-weight: 400;\"> can reduce the body\u2019s absorption of NSAIDs, reducing their effectiveness.<\/span><\/li>\n<li aria-level=\"1\"><b>Proton pump inhibitors (PPIs). <\/b><span style=\"font-weight: 400;\">PPIs, like omeprazole, can increase the risk of kidney damage when combined with NSAIDs.<\/span><\/li>\n<li aria-level=\"1\"><b>Bisphosphonates. <\/b><span style=\"font-weight: 400;\">Taking bisphosphonates, like <\/span><b>alendronate<\/b><span style=\"font-weight: 400;\">, with NSAIDs can increase the risk of stomach irritation.\u00a0<\/span><\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\"><\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\"><\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\"><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">When you\u2019re taking NSAIDs, be sure all of your providers know about all the medications, supplements, and herbal remedies you\u2019re taking. Also, if you have any new or unusual symptoms after beginning a new medication, report them to your doctor right away.<\/span><\/p>\n<h2>Selective NSAIDS (COX-2 Inhibitors)<\/h2>\n<p><img decoding=\"async\" class=\"aligncenter wp-image-1469\" src=\"https:\/\/www.bidrx.com\/blog\/wp-content\/uploads\/2023\/12\/7.jpeg-1.jpg\" alt=\"Celecoxib molecule\" width=\"780\" height=\"520\" \/><\/p>\n<p><span style=\"font-weight: 400;\">Selective COX-2-inhibitors target only the COX-2 enzyme pathway responsible for inflammation and pain. They don\u2019t block the protective COX-1 enzyme, meaning they tend to have fewer gastrointestinal side effects than the nonselective, or traditional, NSAIDs.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">COX-2 inhibitors are often used for conditions where inflammation is a significant component, such as arthritis, gout, and musculoskeletal injuries.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Examples of COX-2 inhibitors are <\/span><a href=\"https:\/\/www.bidrx.com\/home\/medicine_details\/celecoxib-100-mg-capsule\"><b>celecoxib<\/b><\/a><span style=\"font-weight: 400;\"> (Celebrex) and <\/span><b>meloxicam<\/b><span style=\"font-weight: 400;\">.<\/span><\/p>\n<h3>Warnings and Contraindications \u2014 Selective COX-2 Inhibitors<\/h3>\n<p><span style=\"font-weight: 400;\">Drugs in this subtype carry the following warnings:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Increased risk of heart attack and stroke<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Allergic reactions<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Abnormal liver enzyme tests<\/span><\/li>\n<\/ul>\n<h3>Side Effects \u2014 Selective COX-2 Inhibitors<\/h3>\n<p><span style=\"font-weight: 400;\">The most common side effects of selective COX-2 inhibitors include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Skin rashes<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Headaches<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Abdominal pain<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Edema (Swelling)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Hypertension<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Respiratory infections<\/span><\/li>\n<\/ul>\n<h3>Drug Interactions \u2014 Selective COX-2 Inhibitors<\/h3>\n<p><span style=\"font-weight: 400;\">COX-2 NSAIDs can potentially interact with other medications, especially those related to bleeding, blood pressure, kidney function and certain immunosuppressants.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Here are most common drug interactions for selective COX-2 inhibitors:<\/span><\/p>\n<ul>\n<li><b>Anticoagulants. <\/b><span style=\"font-weight: 400;\">Selective COX-2 inhibitors may increase the risk of bleeding when combined with anticoagulant medications such as <\/span><b>warfarin<\/b><span style=\"font-weight: 400;\"> or <\/span><b>heparin<\/b><span style=\"font-weight: 400;\">.<\/span><\/li>\n<li aria-level=\"1\"><b>Aspirin. <\/b><span style=\"font-weight: 400;\">COX-2 inhibitors can diminish the antiplatelet action of aspirin, increasing the risk of blood clots or stroke.<\/span><\/li>\n<li aria-level=\"1\"><b>Antihypertensive medications. <\/b><span style=\"font-weight: 400;\">The use of selective COX-2 NSAIDs with any of the following can reduce the effectiveness of the blood pressure medication:<br \/>\n<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">ACE inhibitors like <\/span><b>lisinopril<\/b><span style=\"font-weight: 400;\">\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Beta blockers, like <\/span><b>metoprolol<\/b><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Angiotensin II receptor blockers (ARBs), like <\/span><b>losartan<\/b><\/li>\n<\/ul>\n<\/li>\n<li aria-level=\"1\"><b>Diuretics. <\/b><span style=\"font-weight: 400;\">Taking these NSAIDs with thiazide diuretics, such as <\/span><b>furosemide,<\/b><span style=\"font-weight: 400;\"> or loop diuretics, like <\/span><b>hydrochlorothiazide<\/b><span style=\"font-weight: 400;\">, can reduce the effectiveness of the diuretic.<\/span><\/li>\n<li aria-level=\"1\"><b>Selective serotonin reuptake inhibitors (SSRIs). <\/b><span style=\"font-weight: 400;\">Taking SSRIs, such as <\/span><b>fluoxetine<\/b><span style=\"font-weight: 400;\"> or <\/span><b>sertraline<\/b><span style=\"font-weight: 400;\">, with COX-2 inhibitors can increase the risk of GI bleeding.<\/span><\/li>\n<li aria-level=\"1\"><b>Lithium. <\/b><span style=\"font-weight: 400;\">COX-2 inhibitors can cause increased lithium levels in the blood, which can lead to toxicity.<\/span><\/li>\n<li aria-level=\"1\"><b>Methotrexate. <\/b><span style=\"font-weight: 400;\">COX-2 inhibitors can cause increased methotrexate levels in the blood, which can lead to toxicity.<\/span><\/li>\n<li aria-level=\"1\"><b>Corticosteroids. <\/b><span style=\"font-weight: 400;\">When combined with COX-2 inhibitors, corticosteroids like <\/span><b>prednisone<\/b><span style=\"font-weight: 400;\"> can cause GI bleeding or ulcers.<\/span><\/li>\n<li aria-level=\"1\"><b>Cyclosporine and tacrolimus. <\/b><span style=\"font-weight: 400;\">Taking selective COX-2 NSAIDs together with the immunosuppressants <\/span><b>cyclosporine<\/b><span style=\"font-weight: 400;\"> or <\/span><b>tacrolimus<\/b><span style=\"font-weight: 400;\"> carries an increased chance of kidney toxicity.<\/span><\/li>\n<li aria-level=\"1\"><b>Other NSAIDs. <\/b><span style=\"font-weight: 400;\">NSAIDs taken with other NSAIDs can cause an increased risk of side effects.<\/span><\/li>\n<li aria-level=\"1\"><b>Digoxin. <\/b><span style=\"font-weight: 400;\">When used concurrently, selective COX-2 NSAIDs can impair digoxin clearance leading to increased blood levels of the drug.<\/span><\/li>\n<li aria-level=\"1\"><b>Antacids. <\/b><span style=\"font-weight: 400;\">Antacids containing <\/span><b>aluminum<\/b><span style=\"font-weight: 400;\"> or <\/span><b>magnesium hydroxide<\/b><span style=\"font-weight: 400;\"> can reduce the body\u2019s absorption of NSAIDs, reducing their effectiveness.<\/span><\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\"><\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\"><\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\"><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">No list of potential drug interactions is complete, and the degree and effects of these medications can vary with the specific NSAID you\u2019re taking. To get a list of potential interactions for a specific medication, visit the Drugs.com <\/span><a href=\"https:\/\/www.drugs.com\/drug_interactions.html\"><span style=\"font-weight: 400;\">Drug Interaction Checker<\/span><\/a><span style=\"font-weight: 400;\">.\u00a0\u00a0<\/span><\/p>\n<h2>A Final Word<\/h2>\n<p><img decoding=\"async\" class=\"aligncenter wp-image-1470\" src=\"https:\/\/www.bidrx.com\/blog\/wp-content\/uploads\/2023\/12\/8.jpeg.jpg\" alt=\"young couple smiling \" width=\"780\" height=\"411\" \/><\/p>\n<p><span style=\"font-weight: 400;\">NSAIDs are real lifesavers when it comes to knocking out pain and inflammation. They&#8217;re great for everything from arthritis to headaches, but these drugs can be a double-edged sword: They do a great job at easing pain and reducing fever, but they can cause some not-so-great side effects, especially if you&#8217;re taking them often or mixing them with other meds.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The key is knowing what you\u2019re dealing with and keeping your doctor informed about all medications you\u2019re taking and your medical history. They will help you decide which of the many NSAID options offers the best benefit-to-risk ratio for your situation.\u00a0<\/span><\/p>\n<h2>Get the Lowest Price for Your NSAIDs<\/h2>\n<p><span style=\"font-weight: 400;\">Now that you\u2019ve educated yourself about NSAIDs, check out BidRx for the lowest price for your medication. Create a bid, and pharmacies will bid on your prescription, allowing you to choose your offer. <\/span><a href=\"https:\/\/www.bidrx.com\/home\/Contents\/medication\"><span style=\"font-weight: 400;\">Create a bid<\/span><\/a><span style=\"font-weight: 400;\"> today and start getting the lowest price for your NSAID medications.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Nonsteroidal anti-inflammatory drugs are a class of medications widely used for their pain-relieving, fever-reducing, and, as the name suggests, anti-inflammatory properties. <\/p>\n","protected":false},"author":2,"featured_media":1463,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[49],"tags":[],"class_list":["post-1462","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-headache-medications"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.bidrx.com\/blog\/wp-json\/wp\/v2\/posts\/1462","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.bidrx.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.bidrx.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.bidrx.com\/blog\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.bidrx.com\/blog\/wp-json\/wp\/v2\/comments?post=1462"}],"version-history":[{"count":3,"href":"https:\/\/www.bidrx.com\/blog\/wp-json\/wp\/v2\/posts\/1462\/revisions"}],"predecessor-version":[{"id":1473,"href":"https:\/\/www.bidrx.com\/blog\/wp-json\/wp\/v2\/posts\/1462\/revisions\/1473"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.bidrx.com\/blog\/wp-json\/wp\/v2\/media\/1463"}],"wp:attachment":[{"href":"https:\/\/www.bidrx.com\/blog\/wp-json\/wp\/v2\/media?parent=1462"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.bidrx.com\/blog\/wp-json\/wp\/v2\/categories?post=1462"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.bidrx.com\/blog\/wp-json\/wp\/v2\/tags?post=1462"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}