Anti-inflammatory Drugs, Nonsteroidal (Systemic)

Precautions While Using This Medicine

If you will be taking this medicine for a long time, as for arthritis (rheumatism), your doctor should check your progress at regular visits . Your doctor may want to do certain tests to find out if unwanted effects are occurring, especially if you are taking phenylbutazone. The tests are very important because serious side effects, including ulcers, bleeding, or blood problems, can occur without any warning.

Stomach problems may be more likely to occur if you drink alcoholic beverages while being treated with this medicine. Also, alcohol may add to the depressant side effects of phenylbutazone.

If you consume 3 or more alcoholic beverages per day, check with your doctor before taking this medicine.

Taking two or more of the nonsteroidal anti-inflammatory drugs together on a regular basis may increase the chance of unwanted effects. Also, taking acetaminophen, aspirin or other salicylates, or ketorolac (e.g., Toradol) regularly while you are taking a nonsteroidal anti-inflammatory drug may increase the chance of unwanted effects. The risk will depend on how much of each medicine you take every day, and on how long you take the medicines together. If your health care professional directs you to take these medicines together on a regular basis, follow his or her directions carefully. However, do not take acetaminophen or aspirin or other salicylates together with this medicine for more than a few days, and do not take any ketorolac (e.g., Toradol) while you are taking this medicine, unless your doctor has directed you to do so and is following your progress .

Before having any kind of surgery (including dental surgery), tell the medical doctor or dentist in charge that you are taking this medicine. If possible, this should be done when your surgery is first being planned. Some of the nonsteroidal anti-inflammatory drugs can increase the chance of bleeding during and after surgery. It may be necessary for you to stop treatment for a while, or to change to a different nonsteroidal anti-inflammatory drug that is less likely to cause bleeding.

This medicine may cause some people to become confused, drowsy, dizzy, lightheaded, or less alert than they are normally. It may also cause blurred vision or other vision problems in some people. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are confused, dizzy, or drowsy, or if you are not alert and able to see well . If these reactions are especially bothersome, check with your doctor.

For patients taking the buffered form of phenylbutazone (e.g., Alka-Butazolidin) :

• This medicine contains antacids that can keep other medicines from working properly if the 2 medicines are taken too close together. Always take this medicine :
  • At least 6 hours before or 2 hours after taking ciprofloxacin (e.g., Cipro) or lomefloxacin (e.g., Maxaquin) .
  • At least 8 hours before or 2 hours after taking enoxacin (e.g., Penetrex) .
  • At least 2 hours after taking itraconazole (e.g., Sporanox) .
  • At least 3 hours before or after taking ketoconazole (e.g., Nizoral) .
  • At least 2 hours before or after taking norfloxacin (e.g., Noroxin) or ofloxacin (e.g., Floxin) .
  • At least 1 to 3 hours before or after taking a tetracycline antibiotic by mouth .
  • At least 1 or 2 hours before or after taking any other medicine by mouth .

For patients taking mefenamic acid :

• If diarrhea occurs while you are using this medicine, stop taking it and check with your doctor immediately. Do not take it again without first checking with your doctor , because severe diarrhea may occur each time you take it.

Some people who take nonsteroidal anti-inflammatory drugs may become more sensitive to sunlight than they are normally. Exposure to sunlight, even for brief periods of time, may cause severe sunburn; blisters on the skin; skin rash, redness, itching, or discoloration; or vision changes. When you begin taking this medicine:

• Stay out of direct sunlight, especially between the hours of 10:00 a.m. and 3:00 p.m., if possible.
• Wear protective clothing, including a hat and sunglasses.
• Apply a sun block product that has a skin protection factor (SPF) of at least 15. Some patients may require a product with a higher SPF number, especially if they have a fair complexion. If you have any questions about this, check with your health care professional.
• Do not use a sunlamp or tanning bed or booth.

If you have a severe reaction from the sun, check with your doctor.

Serious side effects, including ulcers or bleeding, can occur during treatment with this medicine. Sometimes serious side effects can occur without any warning. However, possible warning signs often occur, including severe abdominal or stomach cramps, pain, or burning; black, tarry stools; severe, continuing nausea, heartburn, or indigestion; and/or vomiting of blood or material that looks like coffee grounds. Stop taking this medicine and check with your doctor immediately if you notice any of these warning signs .

Check with your doctor immediately if chills, fever, muscle aches or pains, or other influenza-like symptoms occur, especially if they occur shortly before, or together with, a skin rash . Very rarely, these effects may be the first signs of a serious reaction to this medicine.

Nonsteroidal anti-inflammatory drugs may cause a serious type of allergic reaction called anaphylaxis. Although this is rare, it may occur more often in patients who are allergic to aspirin or to any of the nonsteroidal anti-inflammatory drugs. Anaphylaxis requires immediate medical attention . The most serious signs of this reaction are very fast or irregular breathing, gasping for breath, wheezing, or fainting. Other signs may include changes in color of the skin of the face; very fast but irregular heartbeat or pulse; hive-like swellings on the skin; and puffiness or swellings of the eyelids or around the eyes. If these effects occur, get emergency help at once. Ask someone to drive you to the nearest hospital emergency room. If this is not possible, do not try to drive yourself. Call an ambulance, lie down, cover yourself to keep warm, and prop your feet higher than your head. Stay in that position until help arrives.

For patients taking ibuprofen or naproxen without a prescription:

• Check with your medical doctor or dentist:
  • if your symptoms do not improve or if they get worse.
  • if you are using this medicine to bring down a fever and the fever lasts more than 3 days or returns.
  • if the painful area is red or swollen.