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NSAIDs
Available:
300 mg, 400 mg, 600 mg, and 800 mg for Ibuprofen,
variable for other NSAIDs
Cost:
800 mg, #30 = $7.99 for Ibuprofen, variable for other NSAIDs
Indications:
To reduce inflammation and pain, most commonly pain
associated with joints or soft tissues
Side
effects: Headache, dizziness, fluid retention (swelling
in legs, e.g.), ringing of the ears, itching, and rash
(including hives) are minor side effects. Side effects
related to the stomach may be more serious and can include
nausea, heartburn, stomach or intestinal ulcers, and
bleeding. Less frequently, kidney function may be impaired.
An increased bleeding time and anemia may result as well.
Patients undergoing surgery in the near future may be asked to
stop taking certain NSAIDs several days prior to avoid
bleeding complications.
Monitoring:
Baseline kidney and liver function tests, blood chemistry,
and blood count are recommended. These studies should be
repeated every 6-12 months. Blood pressure, heart rate, and
weight should be monitored with each office visit.
Important
points to know: Better absorption is achieved if these
medications are taken with an empty stomach, but NSAIDs may be
better tolerated if taken with meals. NSAIDs should be taken
with a full glass of water to ensure that the medication has
passed into the stomach. Follow-up is very important so that
the provider can monitor for potential side effects. These
medications should be taken as directed and
over-the-counter NSAIDs should not be taken concurrently.
Special
note: Celecoxib (Celebrex) is an NSAID that is
selective for its effects on COX-2, an enzyme
responsible for inflammation. The use of this medication
results in less stomach-related side effects has no
significant effect on bleeding time. Otherwise, all of the
above side effects apply to this agent that apply to other
NSAIDs. Some controversy has arisen about potential cardiac
side effects after the withdrawal of rofecoxib (Vioxx),
another COX-2 selective drug that demonstrated an increased
rate of heart attacks in clinical studies. Thus far, the
studies are inconsistent and inconclusive about potential
cardiac risks of Celebrex. This drug remains an appropriate
choice for patients needing an NSAID who would be at risk for
stomach-related side effects from traditional NSAIDs.
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