When your muscles ache or your joints throb, you and your doctor may turn to one of the most commonly-used medications to ease the pain: a nonsteroidal anti-inflammatory drug (NSAID), either over-the-counter or prescription. But not all NSAIDs are the same, so how do you pick the right one? Consider these factors.
With close to 20 NSAIDs on the market, it’s often a matter of trial and error to find an effective one, says Clark Kebodeaux, clinical assistant professor at the University of Kentucky College of Pharmacy, in Lexington. Just as people’s bodies are different, so are their responses to certain drugs.
“Two people can take the exact same dose of the exact same drug but have a different response,” he says. Differences in effectiveness may not be evident until you have given one or two – or maybe even three – a try.
Your Health Conditions
NSAIDs are known to cause gastrointestinal (GI) problems. While all NSAIDs work by blocking COX-2, a naturally occurring enzyme that plays a critical role in producing inflammation, most NSAIDs also interfere with the COX-1 enzyme, which plays a role in protecting the lining of the GI tract. The exception is celecoxib (Celebrex), a selective COX-2 inhibitor. By selectively blocking COX-2, celecoxib is safer for the stomach, which is especially important for people who have a history of GI bleeding or stomach upset with traditional NSAIDs. All NSAIDs also increase the risk for heart attack or stroke (especially for those with existing heart disease or risk factors for it). Although studies have suggested that certain NSAIDs are safer for the heart than others, results are inconclusive and further research is needed. One bit of good news: in a very large recent study, celecoxib was found not to increase the risk of heart attack or stroke more than naproxen and ibuprofen do, as had been previously suspected. Some health conditions – kidney disease, heart disease or stomach ulcers, for example – may put NSAIDs completely off-limits.
Many NSAIDs must be taken every four hours; however, a few prescription NSAIDs come in long-acting or extended-release forms – for example, celecoxib, meloxicam (Mobic) and diclofenac sodium (Voltaren XR) – that can be taken as infrequently as once every 24 hours. Once-a-day dosing may be desirable, particularly if you take multiple medications, says Kebodeaux. “Usually the less often you have to take something, the more likely you are to remember it.” Once you have started an NSAID, Kebodeaux advises giving it a while to work. “Patients should be able to see efficacy after a couple of weeks or so,” he says.
And remember this good advice: Reduce your risks of GI or cardiovascular problems by taking the lowest effective dose of an NSAID for the shortest time possible.
Author: Mary Anne Dunkin