Anti-Inflammatory Medications

What are NSAIDs and COXIBs? 

Non-steroidal anti-inflammatory drugs (NSAIDs) are a class of medication used to treat the pain and inflammation of arthritis. They do not contain steroids, hence the name “non-steroidal.” NSAIDs are a very large category of medications, some of which you can obtain without a prescription, such as acetylsalicylic acid (ASA) (e.g., Aspirin®, Entrophen®, Novasen®), ibuprofen (e.g., Motrin® or Advil®) and naproxen (Aleve®). The list of NSAIDs is long, with more than 20 currently available. A COXIB (i.e., celecoxib (Celebrex®)) is an NSAID that has been custom-designed to minimize the risk of stomach ulcers. Although COXIBs are safer on the stomach, they still have all of the other side effects of NSAIDs and may still cause indigestion, nausea, stomach cramps and heartburn.

What are the risks of heart attack and stroke with NSAIDs and COXIBs?

Health Canada and the U.S. Food and Drug Administration (FDA) have reviewed all of the available studies on NSAIDs and COXIBs. Both groups have found that NSAIDs and COXIBs are associated with an increased risk of cardiovascular events (e.g., angina, heart attacks and strokes).

NSAIDs increase the risk of cardiovascular events, but in a small way compared to other risk factors. For example, high blood pressure and smoking pose a greater risk than taking NSAIDs.

The risk is greatest in those patients who use these medications for long periods of time and have risk factors for, or a history of, cardiovascular disease. Health Canada’s recommendations are as follows:

  • Do not use NSAIDs or COXIBs directly before, during or after heart surgery (bypass surgery).
  • Patients with a history of cardiovascular disease (e.g., angina, heart attack, TIA, stroke or congestive heart failure) should be careful using NSAIDs or COXIBs.
  • Patients with risk factors for cardiovascular disease (e.g., diabetes, smoking, elevated cholesterol, obesity and family history) should also be careful using NSAIDs and COXIBs. Safer alternative treatments should be used if available.
  • NSAIDs and COXIBs should be used in the lowest effective dose for the shortest possible duration of time.

If you have cardiovascular disease or risk factors for cardiovascular disease and require an NSAID your prescriber may recommend naproxen. Naproxen has been found to have the lowest risk (among NSAIDs) for cardiovascular events. Please discuss this issue with your health-care provider.