Nonsteroidal anti-inflammatory drugs (NSAIDs) are taken by 80 percent of people with lupus to relieve joint pain, headaches, fever, and chest pain.1 There are many types and brands of NSAIDs, with some over-the-counter and some prescription, including:
- Celecoxib (Celebrex®)
- Diflunisal (Dolobid®)
- Etodolac (Lodine®)
- Ibuprofen (Advil®, Motrin®, Rufen®)
- Indomethacin (Indocin®)
- Ketoprofen (Orudis®, Oruvail®)
- Meloxicam (Mobic®)
- Relafen® (Nabumetone)
- Naproxen (Naprosyn®, Aleve®)
- Oxaprozin (Daypro®, Duraprox®)
- Piroxicam (Feldene®)
- Salsalate (Disalcid®)
- Sulindac (Clinoril®)
- Tolmetin (Tolectin®)
What are the ingredients in NSAIDs?
Each of these NSAIDs has different ingredients which alter how often they will be taken. NSAIDs vary in how strong they are, how long they work to relieve pain and their impact on blood clotting.
How do NSAIDs work?
NSAIDs reduce the inflammation caused by lupus, which in turn reduces pain and helps make joints and muscles less stiff or sore. At a chemical level, NSAIDs block the creation of prostaglandins, a molecule involved in the body’s normal maintenance and inflammatory response. Prostaglandins are controlled by proteins (enzymes) known as COX-1 and COX-2. Most NSAIDs stop your body from making prostaglandins by blocking the COX-1 and COX-2 enzymes. Some newer NSAIDs block only COX-2, such as celecoxib (Celebrex), which is called a Cox-2 inhibitor.1-3
What are the possible side effects of NSAIDs?
As with any drug, NSAIDs can cause side effects, and some are similar to symptoms of a lupus flare. That is why it is important to alert your doctor if you experience any new or worsening symptoms when taking NSAIDs.
Your doctor will also monitor side effects that cannot be seen or felt such as changes in your blood, and kidney and liver function. This is done by reviewing your regular blood test results every three to four months. Side effects of taking NSAIDs include:2,3
- Gastrointestinal issues such as nausea, bloating, vomiting, diarrhea, stomach pain, stomach bleeding, or ulcers
- Kidney issues such as fluid retention, higher blood pressure, or reduced kidney function
- Bruising more easily
- Skin rashes, hives, or a light-sensitive rash
- Increased liver enzymes
- Worsening asthma or inflammatory bowel disease (IBD)
- Increased risk of heart attack or stroke
Many NSAIDs impact blood platelets and lower your blood’s ability to clot. However, if you have antiphospholipid syndrome in addition to lupus, this side effect could be helpful.
People with lupus who take ibuprofen may experience neck stiffness and severe headache.
These are not all the possible side effects of NSAIDs. People taking them should talk to their doctor about what to expect with treatment with NSAIDs.
Stomach irritation and NSAIDs
The first step to protecting your stomach from the irritating effects of NSAIDs is to always eat something before taking your medicine.
If this does not help and NSAIDs upset your stomach or cause pain, your health care provider may recommend taking another medicine to counteract that side effect. Drugs like cimetidine (Tagamet®), omeprazole (Prilosec®), and lansoprazole (Prevacid®) reduce the acid your stomach produces. Misoprostol (Cytotec®) is another medication that may be used to protect against stomach ulcers while taking NSAIDs.
It is important to remember that one NSAID may irritate your stomach and another may not.
Things to know about NSAIDs
Anyone taking NSAIDs long-term should have a regular complete blood count (CBC) test to make sure there is no internal bleeding. This type of bleeding can cause anemia and bruising, and affect blood clotting. Additional tips for long-term NSAID use are:
- Always take NSAIDs with food to reduce stomach irritation.
- You should not take NSAIDs will trying to conceive or while pregnant.
- Limit the alcohol you consume while taking NSAIDs because alcohol may irritate the stomach.
- You should not mix NSAIDs and smoking.
- People with asthma are at higher risk of developing a serious allergic reaction to NSAIDs.
- Children and teenagers should not take aspirin or salsalate.1-3
NSAIDs are known to interact poorly with many other drugs so you should always follow your doctor’s advice about when and how much to take of any pain reliever.