NSAIDs (medication)

A common abbreviation for โ€œNon-Steroidal Anti-Inflammatory Drugsโ€, frequently pronounced as “N-seds”.  They include ibuprofen (Advilยฎ, Motrinยฎ), naproxen (Aleveยฎ, Naprosynยฎ), diclofenac (Voltarenยฎ), and many others.  Aspirin is very similar.  But NSAIDs do not include acetaminophen (Tylenolยฎ).

NSAIDs have 3 pharmacologic properties:

  • anti-inflammatory (relieve inflammation)
  • analgesic (relieve pain)
  • anti-pyretic (relieve fever)

Acetaminophen achieves the last two above, but does not relieve “inflammation“.ย  However, that word commonly gets misused and misunderstood.ย  Usually, the “anti-inflammatory” action is not at all important.

In diseases like Rheumatoid Arthritis, Lupus, etc., joints get inflamed due to action of white blood cells and a variety of chemicals.  NSAIDs decrease this & this decrease pain, whereas acetaminophen does not.  However, NSAIDs do not prevent joint destruction, so they are only an extra bit of help, and never the main treatment.

If you pull a muscle or sprain an ankle, there may be swelling and pain.  But that’s mechanical injury, not “inflammation” in the sense of disease.  So if NSAIDs help, they’re working as analgesics — pain-relievers, no better nor worse than acetaminophen.  Some small animal studies have suggested NSAIDs may even slow healing, by interfering a little with the immune system.

In certain patients, acetaminophen is safer.ย  It doesn’t cause stomach ulcers, won’t injure the kidneys, isn’t bad for high blood pressure or heart failure the way NSAIDs might sometimes be. The two main downsides I encounter with acetaminophen in clinical practice are 1) it can interfere with anticoagulant levels of warfarin (Coumadinยฎ); and 2) it interferes with the continuous glucose monitors diabetics find so useful. ย Acetaminophen may be problematic in patients with severe liver failure (not just any liver disease), but can be taken in half the normal dose (true acetaminophen poisoning occurs with massive all-at-once overdose).ย  By the way, NSAIDs aren’t safe in liver failure either.

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