What Are NSAIDs?

Learn More About NSAIDS and Their Effects

The term NSAID stands for nonsteroidal anti-inflammatory drug. These medications are available over-the-counter and in prescription form and fight pain associated with swelling. Taking NSAIDs increases your body's anti-inflammatory response as well as reducing pain and heat emanating from the injured area.

NSAIDs are available over the counter in low doses, or by a physician's prescription in higher potencies.

Some examples of NSAIDs include ibuprofen, naproxen sodium and aspirin. Common adverse effects of NSAIDs include stomach pain and constipation.

NSAIDs may be used to control chronic pain, or may be used along with other pain medications (such as opioids or adjuvant analgesics) during the treatment of breakthrough pain.

How Do NSAIDs Work?

NSAIDs work by inhibiting the enzyme cyclooxygenase. Notably, COX-1 or COX-2 are the isoforms, or different forms, of cyclooxygenase. By inhibiting cyclooxygenase, NSAIDs decrease the production of prostaglandins. With fewer prostaglandins floating around in your system, pain and inflammation are both decreased.

Newer types of NSAIDS, such as rofecoxib (Vioxx), Celecoxib (Celebrix) and valdecoxib (Bextra), selectively inhibit COX-2 only. Whereas, older types of NSAIDs like aspirin and naproxen sodium inhibit both COX-1 and COX-2 receptors. By inhibiting COX-1 receptors, these older NSAIDS mess with your gastrointestinal (GI) system and predispose you to stomach discomfort and stomach bleeding.

What Happens If You Take Too Many NSAIDS?

Most of the time, when you take too many NSAIDs, the result is stomach pain, or GI discomfort. However, overdose with certain types of NSAIDs, such as oxyphenbutazone, diflunisal, piroxicam, or phenybutazone as well as substantial amounts of ibuprofen, can have serious repercussions including the following:

  • kidney failure
  • heart and lung failure
  • liver problems
  • metabolic acidosis (disruption in levels of body salts)
  • seizures
  • coma
  • blood disorders

What's up With Vioxx and Celebrex?

Between 1999 and 2003, the FDA estimates that Vioxx and Celebrex contributed to almost 28,000 strokes and heart attacks. Thus, these medications were pulled off the market. On a related note, Merck, the maker of Vioxx, ended up paying a nearly $1 billion in a settlement.

How Is Overdose With NSAIDs Diagnosed?

There is no specific test that supports a diagnosis of NSAID overdose. Instead, overdose with NSAIDs is typically diagnosed based on medical history and tests including the following:

  • electrolytes
  • CBC (blood tests)
  • bleeding times (PT/INR)
  • urinalysis
  • glucose

How Is Overdose with NSAIDs Treated?

For mild cases of NSAID overdose that result only in GI, or stomach, discomfort, antacids can provide relief.

When a person experiences a serious overdose attributable to NSAIDs, it's very important to first maintain an open airway and administer supplemental oxygen. Furthermore, seizures and hypotension (a dangerous drop in blood pressure) must be treated quickly, too. If bleeding times are lengthened, vitamin K can be administered. Finally, activated charcoal can be administered to suck up large amounts of NSAIDs in the GI tract.

Please keep in mind that in cases of serious NSAID overdose, it's important to call 911 and inform your physician immediately.

Selected Sources

Tai WW. Chapter 117. Nonsteroidal Anti-Inflammatory Drugs. In: Olson KR. eds. Poisoning & Drug Overdose, 6e. New York, NY: McGraw-Hill; 2012. Accessed January 15, 2016.


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