Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to treat pain, fever, and inflammation. Traditional NSAIDs block COX-1 and COX-2 enzymes that the body uses to manufacture substances called prostaglandins. Since COX-1 prostaglandins are stomach-protective, blocking this enzyme is associated with gastrointestinal toxicity, a known side effect of these drugs. Newer NSAIDs (called COX-2 inhibitors) block primarily COX-2 prostaglandins associated with pain, fever, and inflammation, and might be less risky to the stomach. However, this is not proven, and some COX-2s have been taken off the market due to excess risk of heart attacks attributable to their use. Drugs in this family include:
- Aspirin, alternatively called acetylsalicylic acid or ASA (Adprin-B, Anacin, Arthritis Foundation Aspirin, Ascriptin, Aspergum, Asprimox, Bayer, BC, Bufferin, Buffex, Cama, Cope, Easprin, Ecotrin, Empirin, Equagesic, Fiorinal, Fiorital, Halfprin, Heartline, Genprin, Lanorinal, Magnaprin, Measurin, Micrainin, Momentum, Norwich, St. Joseph, Zorprin)
- Celecoxib (Celebrex)
- Choline salicylate (Arthropan)
- Choline salicylate/magnesium salicylate (Tricosal, Trilisate)
- Diclofenac potassium (Cataflam, Voltaren Rapide)
- Diclofenac sodium (Arthrotec, Voltaren, Voltaren SR, Voltaren-XR)
- Diclofenac sodium/misoprostol (Arthrotec)
- Diflunisal (Dolobid)
- Etodolac (Lodine, Lodine XL)
- Fenoprofen calcium (Nalfon)
- Flurbiprofen (Ansaid)
- Ibuprofen (Advil, Arthritis Foundation Ibuprofen, Bayer Select Ibuprofen, Dynafed IB, Genpril, Haltran, IBU, Ibuprin, Ibuprohm, Menadol, Midol IB, Motrin, Nuprin, Saleto)
- Indomethacin (Indochron E-R, Indocin, Indocin SR, Indomethacin, Indomethacin SR, Novo-Methacin)
- Ketoprofen (Actron, Orudis, Orudis KT, Oruvail)
- Ketorolac tromethamine (Toradol)
- Magnesium salicylate (Doan's, Magan, Mobidin, Backache Maximum Strength Relief, Bayer Select Maximum Strength Backache, Momentum Muscular Backache Formula, Nuprin Backache, Mobigesic, Magsal)
- Meclofenamate sodium (Mecolfen, Meclomen)
- Mefenamic acid (Ponstan, Ponstel)
- Nabumetone (Relafen)
- Naproxen (EC-Naprosyn, Napron X, Naprosyn)
- Naproxen sodium (Aleve, Anaprox, Anaprox DS, Naprelan)
- Oxaprozin (Daypro)
- Piroxicam (Feldene)
- Salsalate or salicylic acid (Amigesic, Argesic-SA, Arthra-G, Disalcid, Marthritic, Mono-Gesic, Salflex, Salgesic, Salsitab)
- Sodium salicylate (Pabalate)
- Sodium thiosalicylate (Rexolate)
- Sulfasalazine (Azulfidine EN-tabs, Salazopyrin, SAS-500)
- Sulindac (Clinoril)
- Tolmetin sodium (Tolectin, Tolectin DS)
- and others
Note : Besides reducing pain and inflammation, aspirin and, to a lesser extent, other NSAIDs interfere with cells in the blood called platelets, which facilitate clotting.
Arginine is an amino acid found in many foods, including dairy products, meat, poultry, and fish. Supplemental arginine has been proposed as a treatment for various conditions, including heart problems.
It may be best not to mix arginine with NSAIDs unless approved by your doctor.
The herb feverfew (Tanacetum parthenium) is primarily used for the prevention and treatment of migraine headaches.
NSAIDs are also used for migraines, so there is a chance that some individuals might use both the herb and drug at once, a combination that may present risks.
The biggest concern with NSAIDs is that they can cause stomach ulcers, which may progress to bleeding or perforation without pain or other warning symptoms. This stomach damage is due to drug interference with the body's protective prostaglandins. Newer NSAIDs called COX-2 inhibitors may be less likely to produce this side effect.
The herb garlic (Allium sativum) is taken to lower cholesterol, among many other proposed uses.
A sugarcane-derived form of the supplement policosanol is used to reduce cholesterol levels. It also interferes with platelet clumping, creating potential benefit as well as a risk of interactions with blood-thinning drugs.
Potassium citrate and other forms of citrate (for example, calcium citrate, magnesium citrate) may be used to prevent kidney stones. These agents work by making the urine less acidic.
It may be advisable to avoid these citrate compounds during therapy with aspirin or salicylates except under medical supervision.
St. John's wort (Hypericum perforatum) is primarily used to treat mild to moderate depression.
The herb dong quai (Angelica sinensis) is often recommended for menstrual disorders such as dysmenorrhea, PMS, and irregular menstruation.
Certain NSAIDs, including most notably piroxicam, can cause increased sensitivity to the sun, amplifying the risk of sunburn or skin rash. Because St. John's wort and dong quai may also cause this problem, taking these herbal supplements during NSAID therapy might add to this risk.
It may be a good idea to wear a sunscreen or protective clothing during sun exposure if you take one of these herbs while using an NSAID.
The substance vinpocetine is sold as a dietary supplement for the treatment of age-related memory loss and impaired mental function.
The bottom line: Seek medical advice before combining vitamin E and aspirin.
The herb white willow (Salix alba) , also known as willow bark, is used to treat pain and fever.
White willow contains a substance that is converted by the body into a salicylate similar to aspirin. It is therefore possible that taking NSAIDs and white willow could lead to increased risk of side effects, just as would occur if you combined NSAIDs with aspirin.
Based on their known effects or constituents, the herbs dong quai(Angelica sinensis) , garlic(Allium sativum) , ginger(Zingiber officinale) , horse chestnut(Aesculus hippocastanum) , and red clover(Trifolium pratense) , and the substances fish oil , mesoglycan , and OPCs (oligomeric proanthocyanidins) might conceivably present an increased risk of bleeding if combined with aspirin.
Cayenne ( Capsicum annuum or C. frutescens ) and other hot peppers used in chili and various dishes contain as their "hot" ingredient capsaicin, a substance that is thought to be stomach-protective.
Colostrum is the fluid that new mothers' breasts produce during the first day or two after birth. It gives newborns a rich mixture of antibodies and growth factors that help them get a good start.
Folate (also known as folic acid) is a B vitamin that plays an important role in many vital aspects of health, including preventing neural tube birth defects and possibly reducing the risk of heart disease. Because inadequate intake of folate is widespread, if you are taking any medication that depletes or impairs folate even slightly, you may need supplementation.
Based on this preliminary evidence, folate supplementation may be warranted if you are taking drugs in the NSAID family.
Licorice root ( Glycyrrhiza glabra or G. uralensis ), a member of the pea family, has been used since ancient times as both food and medicine.
Preliminary evidence suggests that a specific form of licorice called DGL (deglycyrrhizinated licorice) might help protect the stomach against damage caused by the use of aspirin and possibly other NSAIDs. (DGL is a modified version of licorice that is safer to use.)
If you take aspirin regularly, vitamin C supplementation may be advisable.
- Reviewer: EBSCO CAM Review Board
- Review Date: 08/2013 -
- Update Date: 08/22/2013 -