Anti-inflammatory Drugs, Nonsteroidal (Systemic)

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your health care professional will make. For the nonsteroidal anti-inflammatory drugs, the following should be considered:

Allergies - Tell your health care professional if you have ever had any unusual or allergic reaction to any of the nonsteroidal anti-inflammatory drugs, or to any of the following medicines:

• Aspirin or other salicylates
• Ketorolac (e.g., Toradol)
• Oxyphenbutazone (e.g., Oxalid, Tandearil)
• Suprofen (e.g., Suprol)
• Zomepirac (e.g., Zomax)

Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Diet - Make certain your health care professional knows if you are on any special diet, such as a low-sodium or low-sugar diet. Some of these medicines contain sodium or sugar.

Pregnancy - Studies on birth defects with these medicines have not been done in humans. However, there is a chance that these medicines may cause unwanted effects on the heart or blood flow of the fetus or newborn baby if they are taken regularly during the last few months of pregnancy. Also, studies in animals have shown that these medicines, if taken late in pregnancy, may increase the length of pregnancy, prolong labor, or cause other problems during delivery. If you are pregnant, do not take any of these medicines, including nonprescription (over-the-counter [OTC]) ibuprofen or naproxen, without first discussing its use with your doctor.

Studies in animals have not shown that fenoprofen, floctafenine, flurbiprofen, ibuprofen, ketoprofen, nabumetone, naproxen, phenylbutazone, piroxicam, tiaprofenic acid, or tolmetin causes birth defects. Diflunisal caused birth defects of the spine and ribs in rabbits, but not in mice or rats. Diclofenac and meclofenamate caused unwanted effects on the formation of bones in animals. Etodolac and oxaprozin caused birth defects in animals. Indomethacin caused slower development of bones and damage to nerves in animals. In some animal studies, sulindac caused unwanted effects on the development of bones and organs. Studies on birth defects with mefenamic acid have not been done in animals.

Even though most of these medicines did not cause birth defects in animals, many of them did cause other harmful or toxic effects on the fetus, usually when they were given in such large amounts that the pregnant animals became sick.

Breast-feeding -

• For indomethacin : Indomethacin passes into the breast milk and has been reported to cause unwanted effects in nursing babies.
• For meclofenamate : Use of meclofenamate by nursing mothers is not recommended, because in animal studies it caused unwanted effects on the newborn's development.
• For phenylbutazone : Phenylbutazone passes into the breast milk and may cause unwanted effects, such as blood problems, in nursing babies.
• For piroxicam : Studies in animals have shown that piroxicam may decrease the amount of milk.

Children -

• For ibuprofen : Ibuprofen has been tested in children 6 months of age and older. It has not been shown to cause different side effects or problems than it does in adults.
• For indomethacin and for tolmetin : Indomethacin and tolmetin have been tested in children 2 years of age and older and have not been shown to cause different side effects or problems than they do in adults.
• For naproxen : Studies with naproxen in children 2 years of age and older have shown that skin rash may be more likely to occur.
• For oxaprozin : Oxaprozin has been used in children with arthritis. However, there is no specific information comparing use of this medicine in children with use in other age groups.
• For phenylbutazone : Use of phenylbutazone in children up to 15 years of age is not recommended.
• For other anti-inflammatory analgesics : There is no specific information on the use of other anti-inflammatory analgesics in children.

Older adults - Certain side effects, such as confusion, swelling of the face, feet, or lower legs, or sudden decrease in the amount of urine, may be especially likely to occur in elderly patients, who are usually more sensitive than younger adults to the effects of nonsteroidal anti-inflammatory drugs. Also, elderly people are more likely than younger adults to get very sick if these medicines cause stomach problems. With phenylbutazone, blood problems may also be more likely to occur in the elderly.

Other medicines - Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking a nonsteroidal anti-inflammatory drug, it is especially important that your health care professional know if you are taking any of the following:

• Anticoagulants (blood thinners) or
• Cefamandole (e.g., Mandol) or
• Cefoperazone (e.g., Cefobid) or
• Cefotetan (e.g., Cefotan) or
• Heparin or
• Plicamycin (e.g., Mithracin) or
• Valproic acid - The chance of bleeding may be increased

• Aspirin - The chance of serious side effects may be increased if aspirin is used together with a nonsteroidal anti-inflammatory drug on a regular basis

• Ciprofloxacin (e.g., Cipro) or
• Enoxacin (e.g., Penetrex) or
• Itraconazole (e.g., Sporanox) or
• Ketoconazole (e.g., Nizoral) or
• Lomefloxacin (e.g., Maxaquin) or
• Norfloxacin (e.g., Noroxin) or
• Ofloxacin (e.g., Floxin) or
• Tetracyclines, oral - The buffered form of phenylbutazone (e.g., Alka Butazolidin) may keep these medicines from working properly if the 2 medicines are taken too close together

• Cyclosporine (e.g., Sandimmune) or
• Digitalis glycosides (heart medicine) or
• Lithium (e.g., Lithane) or
• Methotrexate (e.g., Mexate) or
• Phenytoin (e.g., Dilantin) - Higher blood levels of these medicines and an increased chance of side effects may occur

• Penicillamine (e.g., Cuprimine) - The chance of serious side effects may be increased, especially with phenylbutazone (e.g., Cotylbutazone)

• Probenecid (e.g., Benemid) - Higher blood levels of the nonsteroidal anti-inflammatory drug and an increased chance of side effects may occur

• Triamterene (e.g., Dyrenium) - The chance of kidney problems may be increased, especially with indomethacin

• Zidovudine (e.g., AZT, Retrovir) - The chance of serious side effects may be increased, especially with indomethacin

Other medical problems - The presence of other medical problems may affect the use of nonsteroidal anti-inflammatory drugs. Make sure you tell your doctor if you have any other medical problems, especially:

• Alcohol abuse or
• Bleeding problems or
• Colitis, Crohn's disease, diverticulitis, stomach ulcer, or other stomach or intestinal problems or
• Diabetes mellitus (sugar diabetes) or
• Hemorrhoids or
• Hepatitis or other liver disease or
• Kidney disease (or history of) or
• Rectal irritation or bleeding, recent, or
• Systemic lupus erythematosus (SLE) or
• Tobacco use (or recent history of) - The chance of side effects may be increased

• Anemia or
• Asthma or
• Epilepsy or
• Fluid retention (swelling of feet or lower legs) or
• Heart disease or
• High blood pressure or
• Kidney stones (or history of) or
• Low platelet count or
• Low white blood cell count or
• Mental illness or
• Parkinson's disease or
• Polymyalgia rheumatica or
• Porphyria or
• Temporal arteritis - Some nonsteroidal anti-inflammatory drugs may make these conditions worse

• Ulcers, sores, or white spots in mouth - Ulcers, sores, or white spots in the mouth sometimes mean that the medicine is causing serious side effects; if these sores or spots are already present before you start taking the medicine, it will be harder for you and your doctor to recognize that these side effects might be occurring