Anti-inflammatory drugs can bring relief to patients suffering from many types of pain. However, these medications also can cause side effects. Some patients may find that anti-inflammatory drugs, particularly nonsteroidal anti-inflammatory drugs (NSAIDs) cause stomach upset. For this reason, these medicines should be taken with food or an antacid, which can lessen the upset.

Mild side effects usually do not require medical attention and may go away as the patient’s body adjusts to the medication. They include:

• Stomach or abdominal pain, cramps or diarrhea
• Dizziness or lightheadedness
• Drowsiness
• Headache
• Heartburn or indigestion
• Nausea or vomiting

Sometimes symptoms are more severe. This is more likely when anti-inflammatory drugs are taken in large doses or over long periods of time (more than one or two months). These can range from those that merely cause discomfort to potentially life-threatening conditions. For this reason, patients should consult with their physician about the pros and cons of taking anti-inflammatory drugs.

Patients should immediately consult a physician if they experience any of the following symptoms after beginning therapy with anti-inflammatories:

• Ulcers or bleeding
• Severe abdominal or stomach cramps, pain or burning
• Black, tarry stools
• Severe, continuing nausea, heartburn or indigestion
• Vomiting blood or material that looks like coffee grounds
• Chills or fever
• Muscle aches or pains (myalgia)
• Fainting
• Fast or irregular heartbeat
• Hive-like swelling on the face, eyelids, mouth or tongue
• Puffiness or swelling of the eyelids or around the eyes
• Breathing difficulties, including wheezing, shortness of breath or chest tightness
• Severe headache

Severe side effects can result if corticosteroids are abruptly discontinued. Patients should discuss with their physician the best way to discontinue a corticosteroid treatment.

In rare cases, patients may experience an extreme allergic reaction to anti-inflammatory drugs known as anaphylactic shock. This is a potentially life-threatening condition that is accompanied by symptoms such as very fast or irregular breathing, gasping for breath or wheezing and fainting. Patients who experience these symptoms require immediate emergency medical care.

For several years, a class of NSAIDs known as COX-2 inhibitors was used to treat individuals who seemed sensitive to earlier types of nonselective NSAIDs. COX-2 inhibitors appeared as capable at reducing pain and inflammation as earlier NSAIDs but did not cause many of the side effects. However, the manufacturers of two COX-2 inhibitors, rofecoxib (Vioxx) and valdecoxib (Bextra), have withdrawn them from the market because of concerns about cardiovascular problems, skin reactions and other concerns. Celecoxib (Celebrex) is the only COX-2 inhibitor still available in the United States.

The U.S. Food and Drug Administration (FDA) warned in 2005 that:

• All NSAIDs except aspirin increase the risk of serious adverse cardiovascular events such as heart attack or stroke.
  
  
• All NSAIDs including aspirin have the risk of serious and potentially life-threatening gastrointestinal bleeding.
  
  
• NSAIDs should not be given to patients immediately after a coronary artery bypass graft.

Before using NSAIDs, patients should discuss the risks, benefits and latest medical research with their physician.

A separate, very serious type of reaction to NSAIDs involves the worsening of an asthma condition. According to the American Academy of Allergy, Asthma and Immunology (AAAAI), at least 10 percent of asthmatics over the age of 10 will experience a worsening of their condition if they take an NSAID, including aspirin. Because so many people have asthma conditions without realizing it (more than 30 percent, according to the AAAAI), anyone who experiences any type of wheezing, coughing or shortness of breath after taking an NSAID should immediately see a physician for a respiratory evaluation.