NSAIDs are used very often as pain relievers in Germany – especially as part of self-medication. However, long-term use can lead to significant side effects. Read here what to consider when taking and when these medications should not be taken.
NSAIDs are short for nonsteroidal anti-inflammatory drugs. These are painkillers (analgesics) that are steroid-free, i.e. do not contain cortisone. Another name for these drugs is non-steroidal anti-inflammatory drugs.
Painkillers in this group are among the most frequently used and prescribed drugs in Germany. Well-known active ingredients from this group are, for example, acetylsalicylic acid, ibuprofen or diclofenac. NSAID drugs are commonly used to relieve pain and treat rheumatic diseases.
At a glance:
Effects and areas of application of NSAIDs
NSAIDs have a pain reliever, antipyretic and anti-inflammatory effect. They can be taken against pain in general and for inflammation of muscles, tendons and joints, for example due to overload, irritation or inflammatory diseases such as rheumatism.
The messenger substances prostaglandins are involved in the development of pain, inflammation or fever. They ensure that pain receptors become more sensitive and pain signals are passed on to the brain more quickly. The production of prostaglandins can be inhibited with NSAID drugs by blocking certain enzymes in the body – the so-called cyclooxygenase 1 and 2 (Cox-1 and Cox-2). This ensures that the production of pain messenger substances is stopped and the transmission to the brain is interrupted. The disadvantage: The enzyme Cox-1 also has a protective function for the mucous membrane in the stomach and intestines. If the enzyme is blocked, it also reduces the protective effect on the mucous membranes. This explains why gastrointestinal complaints are one of the most common side effects of NSAID drugs.
In order to reduce the undesirable side effects for the gastrointestinal tract, a new generation of NSAID drugs, so-called Cox-2 inhibitors, was developed. These are only supposed to block the Cox-2 enzyme.
NSAID drugs work differently depending on the active ingredient. If a drug does not work, switching to another NSAID can be successful.
What NSAID drugs are there?
| Active ingredient / Traditional NSAIDs | field of use |
| Acetylsalicylic acid (ASA) | Mild to moderate pain migraine To inhibit blood clotting Heart attack and thrombosis prevention |
| Ibuprofen | Mild to moderate pain migraine Injuries and swelling of the soft tissues fever Acute arthritis and gout attack Chronic and rheumatoid arthritis Inflammatory rheumatic diseases of the spine, for example Bechterew's disease |
| Diclofenac | In low doses for mild to moderate pain and fever migraine Injuries and swelling of the soft tissues Acute arthritis and gout attack Chronic and rheumatoid arthritis Inflammatory rheumatic diseases of the spine, for example Bechterew's disease |
| Naproxen | Injuries and swelling of the soft tissues Acute arthritis and gout attack Chronic and rheumatoid arthritis Inflammatory rheumatic diseases of the spine, for example Bechterew's disease Abdominal cramps during menstruation |
| Acemetacin | arthrosis Rheumatoid arthritis ankylosing spondylitis Back pain Joke treatment after injuries and operations |
| Cox-2 inhibitors | Short-term treatment for osteoarthritis Long-term treatment of rheumatoid arthritis and ankylosing spondylitis |
| Meloxicam | Short-term treatment for osteoarthritis Long-term treatment of rheumatoid arthritis and ankylosing spondylitis |
| Celecoxib | arthrosis Rheumatoid arthritis ankylosing spondylitis |
| Etoric oxide | Rheumatoid arthritis ankylosing spondylitis Acute gout attacks Pain relief after dental surgery |
Depending on the area of application, the active ingredients are used in different dosage forms such as tablets, suppositories, drops, sprays, gels, ointments or plasters. For example, the analgesic ibuprofen can be taken as a tablet to treat pain or applied externally to the skin as an ointment, spray or plaster to relieve bruises and strains.
Side effects of NSAIDs
As with most drugs, the risk of side effects and complications depends on the active ingredient, the dosage, duration of use and any diseases that are already present. NSAID analgesics should therefore always be dosed as low as possible and only taken for as long as necessary. All NSAIDs can cause harm if taken continuously for several months and at high doses. The most common complications affect the gastrointestinal tract:
The risk of gastrointestinal damage can be reduced by using drugs that protect the stomach. These are often prescribed to people who have been taking NSAID medication for longer and who are at increased risk of stomach ulcers or mucosal infections.
Long-term use and high doses of NSAIDs can also favor cardiovascular diseases such as heart attacks or strokes. An exception is acetylsalicylic acid (ASA), which is used in low doses to prevent heart attacks because it has a blood-thinning effect.
When taking NSAIDs, central nervous disorders such as ringing in the ears, dizziness, visual disturbances, headache or tiredness can occur. Allergies to individual active ingredients or ingredients are also possible.
Basically: For each individual active ingredient there are special notes on side effects, interactions, contraindications and warnings that must be observed.
Interactions
When taking NSAIDs and other drugs or active ingredients, there may be interactions. Effects can be increased or weakened or complications can occur. When using prescription drugs, you should therefore always discuss the use of additional drugs with your doctor. The most common known interactions are:
NSAIDs and glucocorticoids: increases the risk of gastrointestinal complications
NSAIDs and antiplatelet drugs and selective serotonin reuptake inhibitors: increases the risk of gastrointestinal bleeding
NSAIDs and oral antidiabetic drugs: increase the blood sugar lowering effect
NSAIDs and diuretics: the diuretic effect is weakened
NSAIDs and coumarin derivatives and other anticoagulants: increases the blood clotting effect
NSAIDs and antihypertensive drugs, especially ACE inhibitors: reduces the antihypertensive effect
When should NSAID drugs not be used?
For all NSAIDs, it is recommended not to take them:
- In the last trimester of pregnancy
- For gastrointestinal ulcers
Depending on the active ingredient in the analgesic, other contraindications must also be observed. The use of NSAID medication should be discussed with your doctor, especially if you have pre-existing conditions such as:
Special feature: ASS in children
Children should only be given ASA pain relievers if a doctor has prescribed or specifically recommended them. Acetylsalicylic acid is suspected of causing so-called Reye's syndrome in children, especially in connection with a feverish viral infection. The disease causes acute brain and liver damage that can lead to death undetected.
NSAIDs: how long to take?
It is recommended that NSAIDs only be taken when needed and in low doses. People with chronic pain should always discuss the duration and dosage with their doctor.