NSAIDs: Summary of Recommendations
The nonsteroidal anti-inflammatory drugs (NSAIDs) are the most frequently used medicines to treat osteoarthritis—the most common form of arthritis—and mild to moderate pain. They cost from about $4 to more than $1,500 a month. This report shows how you could save hundreds of dollars a month or more.
Since individual needs vary, use the information in this report to talk with your doctor about the medicine and dose that is right for you, and the possible risks.
NSAIDs should be used with caution. All increase the risk of serious side effects, including stomach ulcers, gastrointestinal bleeding, kidney failure, heart attacks, and strokes. Except for low-dose aspirin and naproxen, NSAIDs might not be appropriate for people at risk of heart disease or stroke. Don't take them for long periods of time without consulting a doctor.
Taking effectiveness, safety, and cost into account, we have chosen two NSAIDs as Consumer Reports Best Buy Drugs:
- Naproxen - generic prescription and over-the-counter
- Ibuprofen - generic prescription and over-the-counter
These are inexpensive medicines that are as effective as other NSAIDs when used in comparable doses. Naproxen may be a better choice for people who have higher risk of heart attacks or strokes, since the available evidence indicates it does not increase the risk of these conditions.
If you are at increased risk of bleeding due to older age, use of aspirin or other blood thinners, or a history of prior bleeding or ulcers, talk to your doctor before starting an NSAID. Celecoxib (Celebrex) may be an alternative in some situations, or taking an acid blocker to help protect the stomach. Celecoxib is no more effective at relieving pain than ibuprofen or naproxen, but is more expensive, so it is not a top choice for most people.
NSAIDs applied to the skin (topical) can be as effective as NSAID tablets or capsules for localized arthritis pain, but it is not yet clear if they cause fewer, serious side effects than oral NSAIDs. Also, they are more expensive. Our advice:
- If you have had a stomach ulcer or bleeding, or are at high risk of either, talk with your doctor about the potential risks of taking NSAIDs and treatment alternatives. The risk of bleeding from NSAID use increases with age.
- If you have heart disease or are at risk of a heart attack or stroke, talk with your doctor about the potential risks of taking any NSAID.
- If you have kidney disease or high blood pressure, talk with your doctor about the risks of taking NSAIDs for long periods of time.
- Take the lowest dose of an NSAID that brings relief and do not take any longer than necessary.
- NSAIDs can interact with other medicines, including other NSAIDs, such as aspirin, and increase the risk of serious side effects. If your doctor prescribes an NSAID, tell him or her about any other medicines or dietary supplements you are taking, including daily aspirin to reduce your risk of heart attack or stroke.