How to Take Your Medicine: Nonsteroidal

From the FDA Consumer Magazine

How you take a drug makes a big difference in how well it will work and how 
safe it will be fore you. Timing, what you eat and when you eat, proper 
dose, and many other factors can mean the difference between feeling better, staying the same, or even feeling worse. This drug information page is
intended to help you make your treatment work as well as possible. It is
important to note, however, that this is only a guideline. You should talk
to your doctor or pharmacist about how and when to take any prescribed drugs. 

This first installment of a series of articles on commonly prescribed drugs 
is about nonsteroidal anti-inflammatory drugs, often abbreviated NSAIDs.

Conditions These Drugs Treat
* symptoms such as redness, warmth, swelling, stiffness, and joint pain 
caused by rheumatoid arthritis, osteoarthritis, and other rheumatic 
conditions
* menstrual cramps
* pain, especially that associated with dental problems, gout, episiotomy 
(an incision made in a woman’s perineum and vagina during childbirth to 
prevent tearing), tendinitis, bursitis, and injuries such as sprains and
strains.

NSAIDs are not a cure for arthritis or any other disease. These drugs 
temporarily relieve pain by blocking the body’s production of chemicals 
known as prostaglandins, which are believed to be associated with the pain
and inflammation of injuries and immune reactions.

How to Take 

Indomethacin and phenylbutazone should always be taken with food. The food
helps prevent an upset stomach, which NSAIDs can cause. Meclofenamate may be taken with meals. For other NSAIDs, however, your doctor may tell you to take the first several doses 30 minutes before or two hours after eating.  This will help the medicine relieve the symptoms more quickly.

Like food, antacids may prevent an upset stomach when you’re taking NSAIDs.  However, both food and some over-the-counter antacids may interfere with an  NSAID’s effectiveness. Ask your doctor for the best approach for a particular NSAID. 

NSAID tablets and capsules should be washed down with eight ounces of water  to help prevent the drugs from irritating the delicate lining of the
esophagus and stomach. In addition, to let gravity help move the pills
along–don’t lie down for at least 15 to 30 minutes after each dose.

Be sure to take the right number of tablets or capsules for each dose.
Liquid doses are best measured in special spoons available from your
pharmacist. Teaspoons or tablespoons from the kitchen drawer are rarely the 
right dosage size.

Missed Doses

Ask your doctor what to do if you forget to take a dose. Some NSAIDs have a
longer-lasting effect in the body than others, so you’ll need your doctor’s 
guidance on whether to make up a missed dose of the specific NSAID you are
taking, or just wait until it’s time for the next dose. 

But never take a double dose. 

Be sure to refill your prescriptions soon enough to avoid missing any doses.

Relief of Symptoms

Most NSAIDs start to relieve pain symptoms in about an hour. However, for 
long-term inflammation and for severe or continuing arthritis, relief may 
not come for a week to several weeks. 

How long you will need to take the medicine depends on the condition being
treated. Make sure you understand your doctor’s instructions. 

Side Effects and Risks

Common side effects include nausea, cramps, indigestion, and diarrhea or
constipation. Other side effects can include increased sensitivity to 
sunlight, nervousness, confusion, headache, drowsiness, or dizziness. If you
have any of these side effects, notify your doctor, but don’t stop taking 
your medication on your own.

Occasionally, NSAIDs can cause ulcers or bleeding in the stomach or small 
intestine. Warning signs include severe cramps, pain, or burning in the 
stomach or abdomen; diarrhea or black tarry stools; severe, continuing
nausea, heartburn, or indigestion; or vomiting of blood or material that
looks like coffee grounds. If any of these side effects occurs, stop taking 
the medicine and call your doctor immediately.

Other serious but rare reactions are: 
* Anaphylaxis–Signs of this severe allergic reaction are very fast or
difficult breathing, difficulty in swallowing, swollen tongue, gasping for
breath, wheezing, dizziness, or fainting. A hive-like rash, puffy eyelids,
change in face color, or very fast but irregular heartbeat or pulse may also
occur. If any of these occurs, get emergency help at once.
* With phenylbutazone, sore throat or fever can be early signs that the drug
has impaired the bone marrow’s ability to produce blood cells. Call your
doctor immediately. Because of the seriousness of this side effect, 
phenylbutazone is usually prescribed as a last resort and then for short
periods only. 
* Unusual swelling of the fingers, hands or feet, weight gain, or decreased 
or painful urination can indicate worsening of an underlying heart or kidney
condition. If any of these symptoms occurs, call your doctor. 

Precautions and Warnings
* NSAIDs should not usually be taken during pregnancy or while
breast-feeding. 
* People 65 and older are more likely to experience the side effects of 
NSAIDs and get sicker with those effects than younger adults. 
* Alcoholic beverages should be avoided, as they increase the potential for 
stomach problems while taking NSAIDs. 
* Don’t take acetaminophen or aspirin or other salicylates with NSAIDs
unless directed by your doctor. Taking these drugs along with NSAIDs may
increase the risk of side effects.
* Tell your physician if you are taking any other medication–prescription
or nonprescription. 
* Before any surgery or dental work, tell the physician or dentist that you 
are taking NSAIDs.
* Don’t drive or operate machines if the medicine makes you confused, 
drowsy, dizzy, or lightheaded. Learn how the medicine affects you first.
* NSAIDs can increase sensitivity to sunlight in some people. To avoid the
risk of a serious sunburn, stay out of direct sunlight, especially between
10 a.m. and 3 p.m.; wear protective clothing; and apply a sunblock with a 
skin protection factor of 15. 

–Dori Stehlin

Don’t store drugs in the bathroom medicine cabinet. Heat and humidity may 
cause the medicine to lose its effectiveness. 

Keep all medicines, even those with child-resistant caps, out of the reach
of children. Remember, the caps are child-resistant, not child-proof. 

Discard medicines that have reached the expiration date shown on the label.