NSAIDs

(Non-steroidal anti-inflammatory drugs)

• Celecoxib (Celebrex)
• Diflunisal (Dolobid)
• Etodolac (Lodine)
• Ibuprofen (Advil, Motrin, Rufen)
• Indomethacin (Indocin)
• Meloxicam (Mobic)
• Midrin
• Nabumetrone (Relafin)
• Naproxen (Naprosyn, Alleve)
• Oxaprozin (Daypro, Duraprox)
• Piroxicam (Feldene)
• Salsalate (Disalcid)
• Sulindac (Clinoril)
• Tolmetin (Tolectin)
• Trilisate
• Ketoprofen (Orudis, Oruvail)

What are NSAIDs?

NSAID stands for “non-steroidal anti-inflammatory drug.” These anti-inflammatory medications relieve some lupus symptoms by reducing the inflammation responsible for the stiffness and discomfort in your muscle, joints, and other tissues. NSAIDs are milder than many other lupus drugs and may be taken either alone to treat a mild flare or in combination with other medications. NSAIDs come in both prescription and over-the-counter forms, but you should always talk to your doctor before taking any over-the-counter medication. There are many NSAIDs currently on the market; common examples include ibuprofen (Advil, Motrin), naproxen (Naprosyn, Alleve), etodolac (Lodine), celecoxib (Celebrex), and meloxicam (Mobic). Everyone responds differently to different medications, so you and your doctor should work together to find the most effective NSAID for your lupus symptoms.

How do NSAIDs work?

NSAIDs work at a chemical level by blocking the formation of molecules in your body called prostaglandins. Prostaglandins are involved in both your body’s normal “maintenance” and your body’s inflammatory response. These prostaglandins are controlled by enzymes—proteins that help to bring about chemical changes in your body—called Cox-1 and Cox-2. Specifically, Cox-1 controls the formation of the prostaglandins involved in the normal function of many of your body’s organs. Cox-2 controls the formation of the prostaglandins involved in your body’s inflammatory response. So, by stopping your body from making prostaglandins, NSAIDs allow you to experience less swelling and less pain.

Most NSAIDs block both Cox-1 and Cox-2 enzymes. Since the Cox-1 enzyme helps some of your organ systems to function normally, you may experience some side effects when taking NSAIDs, such as upset stomach. [A full list of possible side effects can be found below.] However, some newer NSAIDs, such as celecoxib (Celebrex), block only the Cox-2 enzyme, which may help your body to avoid some of the more traditional side effects. A Cox-2 inhibitor is sometimes called a “selective” inhibitor. Your doctor will help you to decide which type of NSAID works best to treat your lupus symptoms, while minimizing the possible side effects.

What side effects can occur from taking NSAIDs?

NSAIDs can cause certain side effects. These side effects can be similar to symptoms of increased lupus, so it is important to notify your doctor if they occur. Most side effects will go away once the drug is stopped. Some side effects will only be apparent from your blood tests, so it is important to get regular complete blood counts (CBCs) every 3-4 months, including tests of your liver and kidney function.

Potential side effects of NSAIDs include:

  • Upset Stomach
  • Headache
  • Easy bruising
  • High blood pressure
  • Fluid retention
  • Dyspepsia (gnawing or burning pain in the pit of your stomach, sometimes with bloating)
  • Gastritis (stomach inflammation) or gastric ulcers may occur, causing either hidden or apparent bleeding. This blood loss may lead to anemia.
  • Increased risk of heart attack or stroke.
  • Effects on blood platelets, cells that help your blood to clot normally – Most NSAIDs have some effect on blood platelets. When platelet function is reduced, it takes longer for your blood to clot. While this effect can be bad for some, it can be beneficial for others. In fact, aspirin is often prescribed to reduce the risk of blood clots in people who have antiphospholipid antibodies. However, it is important that you speak to your doctor before taking any NSAIDs if you are on low-dose aspirin therapy, since certain NSAIDs such as ibuprofen (Advil, Motrin, Rufen) can interfere with the effectiveness of this treatment. Selective inhibitors (Celebrex) do not affect platelets.
  • If you already have blood pressure or kidney problems, NSAIDs may worsen kidney function. Fluid retention or further elevation in blood pressure may occur. Reduced kidney function can occur with either Cox-1 or Cox-2 inhibitors. If you have lupus nephritis, you and your doctor should closely supervise your use of NSAIDs to reduce the potential for further harm to your kidneys.
  • Occasionally lupus patients may experience elevations in their liver enzyme blood tests, suggesting a mild liver inflammation (hepatitis). Usually this does not mean that the medication must be stopped, but liver tests should be performed on a regular basis.
  • Worsening of symptoms in people with asthma or inflammatory bowel disease.
  • Severe headache with neck stiffness may occur exclusively in people with lupus, usually only with ibuprofen.
  • Skin rashes can occur, either in the form of hives or a light- or sun-sensitive rash. Sometimes these rashes can mimic a flare of your lupus, so it is important you speak with your doctor if you experience this reaction. This reaction is more common with piroxicam (Feldene)

What if NSAIDs irritate my stomach?

Always take NSAIDs with food to help protect your stomach from irritation. If you experience stomach pain or other side effects when taking NSAIDs, your doctor may prescribe medications to control these symptoms. Medications such as cimetidine (Tagamet), ranitidine (Zantac), omeprazole (Prilosec), and lansoprazole (Prevacid) help your stomach from producing acid. Misoprostol (Cytotec) may help to maintain the protective lining of your stomach wall. It is important to remember that you may experience stomach irritation from one NSAID but not another. Speak with your doctor if you are experiencing stomach pain. There could be another drug that works better for you.

What should I keep in mind if I have been taking NSAIDs for a long time?

If you have been undergoing long term NSAID therapy, you should have your blood count measured periodically (a test called a CBC) to make sure you are not experiencing any hidden gastric bleeding. This type of bleeding can cause anemia, which affects your blood’s ability to clot and can lead to easy bruising.

Limit your alcohol intake while taking NSAID medications, since alcohol can irritate the stomach. People taking NSAID medications should not smoke. In fact, individuals with lupus should not smoke at all due to their increased risk of cardiovascular disease (the number one cause of death in lupus patients).

Lastly, it is important that you talk to your doctor about any other medications—prescription and over-the-counter drugs, vitamins, and supplements—that you may be taking.

Can I take NSAIDs if I am pregnant or thinking of having a baby?

NSAIDs are forbidden during pregnancy, even while trying to conceive.

Talk to your doctor if you:

  • Have decreased kidney or liver function, or an uncontrolled or undiagnosed liver problem (for example, hepatitis)
  • Have ever had an ulcer, gastritis, or bleeding from the intestinal tract
  • Take blood thinners (anticoagulants) like Coumadin, heparin, aspirin, or Plavix
  • Take steroids such as prednisone
  • Have a low platelet count
  • Have Crohn’s disease or ulcerative colitis
  • Have a history of stroke, heart attack, hypertension, or congestive heart failure
  • Have asthma or chronic lung disease
  • Are allergic to aspirin or any other NSAIDs
  • Have nasal polyps
  • Have ‘reflux disease,’ indigestion, or hiatal hernia
  • Are pregnant, may become pregnant, or are breast feeding
  • Drink more than 7 alcoholic drinks per week or more than 1 per day
  • Are over 65
  • Do not accept blood products due to religious or other reasons.

Get emergency help right away if you experience any of the following symptoms:

  • Chest pain
  • Shortness of breath
  • Weakness in one part of the body
  • Slurred speech.