Patients should consult their physician before taking any additional prescriptions, over-the-counter medications, nutritional supplements or herbal medications. Of particular concern to individuals taking nonsteroidal anti-inflammatory drugs (NSAIDs) are:

• Aspirin.  There is conflicting evidence about the effect of other NSAIDs on aspirin. Some studies suggest that some types of NSAID may reduce aspirin’s effectiveness in patients having a heart attack. Other studies have suggested that regular – but not intermittent – use of NSAIDs may have an impact on the effects of aspirin. There is an increased chance of gastrointestinal bleeding if NSAIDs are combined with aspirin.
  
  
• Corticosteroids. NSAIDs taken in conjunction with corticosteroids (which are another type of anti-inflammatory drug) may increase the risk of peptic ulcers.
  
  
• Triamterene. This diuretic increases the chance of kidney problems when taken with NSAIDs.
  
  
• Antiemetics (medications that prevent or stop vomiting). Used in conjunction with NSAIDs, antiemetics may not be as effective.
  
  
• Blood pressure medications. Taking NSAIDs may reduce the effectiveness of these drugs.
  
  
• Chemotherapy drugs. Taking NSAIDs may increase the toxicity of some cancer fighting drugs.
  
  
• Arthritis, gout or diabetes medications. These drugs can interact with NSAIDs in some instances.
  
  
• Anticoagulants (medications that inhibit the blood’s ability to clot). Taking NSAIDs along with anticoagulants may increase the risk of excessive bleeding.
  
  
• Lithium carbonate. The effect and toxicity of this compound used to treat bipolar disorder may increase when taken along with NSAIDs.
  
  
• Immunosuppressants (medications that suppress the immune system). These may lessen the medicinal effects of NSAIDs.
  
  
• Cigarettes and alcohol. Smokers have an increased risk of developing gastric ulcers from NSAID use. Nausea and bleeding are common when NSAIDs are taken with alcohol.
  
  
• Vitamin E supplements and omega-3 fatty acid supplements. Each of these increases the likelihood of bleeding when taken along with NSAIDs.
  
  
• Zinc. Reduces the absorption and effectiveness of NSAIDs.

In addition, NSAID use can decrease melatonin levels in the body.

Supplements that help build cartilage in joints (e.g., chondroitin, glucosamine) may enhance the anti-inflammatory properties of NSAIDs. Copper supplements may bind to NSAIDs and increase their anti-inflammatory properties as well. People with insomnia may sleep more easily when an NSAID (e.g., aspirin, ibuprofen) is taken before bed. NSAIDs should never be taken with other pain relievers or anti-inflammatory medications unless under the direction of a physician.

It is important for patients to tell their physician all the medications they are currently taking, whether prescribed or over the counter.