Our local pharmacist, Tina, answers your questions on Anti-Inflammatory Medications

Anti-inflammatory medications (NSAIDs) are often recommended by many health professionals, including Physiotherapists and General Practitioners, in the management of musculoskeletal injuries. But before you reach into your drawer to get that dusty pack of Nurofen out, we recommend reading below.

We ask our go-to Port Melbourne pharmacist, Tina Coombs (Port Melbourne Pharmacy), some of the most frequently asked questions when it comes to anti-inflammatory medication.

 What are the differences between an over-the-counter (OTC) anti-inflammatory medications like ibuprofen vs a prescribed anti-inflammatory such as Celebrex (Celecoxib)? 

Over-the-counter  & prescription anti-inflammatory medications are often the same or very similar.  Often the strength of the active ingredient or the number of tablets in the pack determines if the medication can be purchased with or without a doctor’s prescription. 

As this family of drugs (NSAIDs) can interact with other medications & should not be taken at all with some health conditions, I strongly recommend that you have a discussion with a health care professional before taking them to ensure that the most appropriate choice has been made for your individual requirements. 

If over-the-counter ibuprofen doesn’t work for me, does this mean that Celebrex won’t work for me either? 

Not always. There are many factors involved. If your physiotherapist recommends an anti-inflammatory medication after assessing/treating you, have a chat with your local pharmacist who will recommend the most suitable choice for your needs. Each of the NSAIDs have slightly different modes of action including the time it takes to provide pain relief, the length of time that they last for and of course if they can be taken in combination with medications/conditions that you may already have. 

When a pharmacist is deciding which NSAID to recommend, many things need to be considered e.g. – age/pre-existing medical conditions, current medications or supplements usage, the dose of the NSAID etc. All of these help to decide the most appropriate choice to deliver the safest and best result.

How long should I take ibuprofen for? 

You may have heard or read that NSAIDs can cause side effects like kidney damage and stomach ulcers or blood loss in some people. These are good reasons why they shouldn’t be taken indiscriminately or for prolonged periods of time without review.

If ibuprofen has been chosen as the most appropriate drug for the condition & person, the lowest effective dose should be taken for the shortest possible time.  This will differ according to the injury - is it minor (acute) or potentially longer-standing (chronic)? 

Short-term use is generally up to 5 days.

Doctors will often prescribe gastro-protective agents to prevent adverse side-effects if the anti-inflammatory needs to be taken in high doses or for a longer period of time.

Some people may not be able to tolerate oral anti-inflammatories & a topical anti-inflammatory in cream or gel form may be recommended. I sometimes recommend taking paracetamol with the anti-inflammatory as it can give additional pain relief in many situations. The application of hot or cold packs can also be of benefit. 

Do I need to take my ibuprofen with food? 

We used to routinely say “take with food”   thinking that this would protect the stomach but we now encourage people to “take with a full glass of water” which carries the drug past the stomach and increases the absorption & effectiveness of the medication. 

What are some of the negative side effects of regular ibuprofen usage? Is it ok for my kidney/liver? 

Ibuprofen can cause gastro-intestinal side-effects such as reflux or more serious events such as bleeding. These side-effects are more likely if the drugs are taken for longer periods of time.  

Kidney damage can occur if you are also taking certain medications for other conditions such as high blood pressure or heart disease or have diabetes - this is why you must first discuss with a doctor or pharmacist.

Neither Celebrex or ibuprofen are considered to be hard on the liver. NSAIDs rarely cause liver damage for people without liver problems. But they’re not always recommended for people with liver disease. You should check with your healthcare provider before taking NSAIDs if you have a history of liver problems. 

Reassuringly, the risk of a cardiovascular event such as a heart attack, stroke, or death is  small when NSAIDs are prescribed for short periods of time - such as for a musculoskeletal injury - in people at low cardiovascular risk. 

Do anti-inflammatories impact blood pressure? 

Yes they can. 

• All NSAIDs in doses adequate to reduce inflammation and pain can increase blood pressure in people with normal blood pressure and those with high bp (even if they are taking medication to control it). The average rise in blood pressure varies considerably. 

• NSAIDs can make your body retain fluid and decrease kidney function, leading to higher blood pressure. 

• NSAIDs can raise the risk of heart attack or stroke, especially in higher doses. 

It is generally recommended to avoid NSAIDs if you have a history of high/unstable  blood pressure or other heart-related conditions. 

In summary, you should always talk to your healthcare provider before taking NSAIDs, especially if you already take other medications or have certain medical conditions. Always discuss taking a NSAID with a healthcare provider if you already take a blood thinner/anticoagulant. Do not just purchase these over the counter without a consultation because you may experience uncontrollable bleeding in your brain, gut, bladder, or lungs. 

If your healthcare provider thinks you would benefit from a NSAID, then it should be taken at the lowest possible dose for the shortest possible time. 

The bottom line 

Both Celebrex and ibuprofen have their pros and cons. But the medication you use will depend on your particular situation. NSAIDs like Celebrex and ibuprofen are effective for treating many types of pain. But they can also have serious side effects. Talk to your healthcare provider about which medication is right for you. 

The advice in this blog is general in nature and is not a substitute for medical advice. If you have concerns, we encourage you to seek further information with you treating pharmacist or doctor.

We thank Tina for taking the time to share her wealth of knowledge.