Drugs, Devices & Supplements 
 
 Non-Steroidal Anti-Inflammatory Medicines (NSAIDs) (Also Called 'NSAID', 'Motrin', 'Ibuprofen', 'Naproxen') 
 
 What do nonsteroidal anti-inflammatory drugs do? 
 
 Nonsteroidal anti-inflammatory drugs (NSAIDs) effectively reduce inflammation (swelling) and relieve pain. Inflammation is the body's way of protecting itself after irritation or an injury. Signs of inflammation include redness, warmth, swelling, and pain. 
 
 NSAIDs are used to treat a variety of symptoms such as pain, inflammation, and stiffness caused by rheumatoid arthritis and tendonitis. NSAIDs are also used to treat several other conditions, such as: 
 
 Osteoarthritis 
 
 Muscle aches 
 
 Backaches 
 
 Dental pain 
 
 Pain caused by gout 
 
 Bursitis, and 
 
 Menstrual cramps 
 
 They may also be used to reduce fever or relieve minor aches caused by the common cold. 
 
 How do NSAIDs work? 
 
 NSAIDs work by blocking the production of certain body chemicals that cause inflammation. NSAIDs are effective in treating pain caused by slow, prolonged tissue damage, such as the pain from an arthritic joint. NSAIDs are also effective in treating general or localized pain, such as back pain, menstrual cramps, and headaches. 
 
 NSAIDs work like corticosteroids (also called steroids), without many of the side effects of steroids. Steroids are man-made drugs that are very similar to cortisone, a naturally-occurring hormone. Like cortisone, NSAIDs are effective in reducing pain and inflammation often associated with joint and muscle diseases and injuries. 
 
 Are NSAIDs available without a prescription? 
 
 Yes. Over-the-counter NSAIDs are available without a prescription, in much lower doses than prescription NSAIDs. Current over-the-counter NSAIDs include: 
 
 Aspirin compounds (such as Anacin ® , Ascriptin ® , Bayer ® , Bufferin ® and Excedrin ® ) 
 
 , Ascriptin , Bayer , Bufferin and Excedrin ) Ibuprofen (such as Motrin ® and Advil ® ) 
 
 and Advil ) Naproxen sodium (such as Aleve®) 
 
 Over-the-counter NSAIDs are effective in treating mild osteoarthritis and some muscle injuries. Ibuprofen and naproxen are also used to treat fever. As with any medication, always follow the directions on the label and the instructions from your healthcare provider. 
 
 How long should I use an over-the-counter NSAID? 
 
 Never use an over-the-counter NSAID continuously for more than three days for fever, and 10 days for pain, without talking to your healthcare provider. Over-the-counter NSAIDs are effective pain-relievers, but they are intended for short-term use. When taking NSAIDs for long periods of time, you should be carefully monitored by your healthcare provider so he or she can watch for harmful side effects and change your treatment, if necessary. 
 
 How long do NSAIDs take to work? 
 
 Depending on the NSAID and the condition being treated, some NSAIDs may work within a few hours, while others may take a week or two before most benefits are achieved. Generally, for acute muscle injuries, we recommend NSAIDs that work quickly; however, these may need to be taken as often as every four to six hours because of their short action time. 
 
 For osteoarthritis and rheumatoid arthritis that need long-term treatment, we usually recommend NSAIDs that need to be taken only once or twice a day. However, it generally takes longer for these drugs to have a therapeutic (healing) effect. 
 
 When are NSAIDs prescribed? 
 
 NSAIDs are often prescribed for rheumatologic diseases, including rheumatoid arthritis and moderate-to- severe osteoarthritis. NSAIDs are also prescribed for moderately painful musculoskeletal conditions such as back pain. 
 
 How are NSAIDs prescribed? 
 
 NSAIDs are prescribed in different doses, depending on the condition that is being treated. These drugs may need to be taken from one to four times a day. Do NOT increase the dose without asking your health care provider first. 
 
 Your healthcare provider may prescribe higher doses of NSAIDs if you have rheumatoid arthritis, for example, because this disease often causes a significant degree of heat, swelling, and redness and stiffness in the joints. Lower doses may be prescribed for osteoarthritis and acute muscle injuries, since there is generally less swelling and frequently no warmth or redness in the joints. 
 
 No single NSAID is guaranteed to work. Your healthcare provider may prescribe several types of NSAIDs in order to find the one that works best for you. Avoid aspirin and alcoholic beverages while taking NSAIDs. 
 
 What are some prescription NSAIDs? 
 
 Below is a list of some prescription NSAIDS. Please note: this is NOT an all-inclusive list. In addition, many NSAIDs are only available as generic formulations. 
 
 Generic name/brand name (if still available) 
 
 celecoxib (Celebrex ® ) 
 
 ) diclofenac (Voltaren ® [available by brand name in topical form]) 
 
 [available by brand name in topical form]) diflunisal 
 
 etodolac 
 
 fenoprofen (Nalfon ® ) 
 
 ) flurbiprofen 
 
 ibuprofen 
 
 indomethacin (Indocin ® [available by brand name in liquid form]) 
 
 [available by brand name in liquid form]) ketoprofen 
 
 ketorolac tromethamine 
 
 meclofenamate sodium 
 
 mefenamic acid (Ponstel ® ) 
 
 ) meloxicam (Mobic ® ) 
 
 ) nabumetone 
 
 naproxen sodium (Anaprox ® , Naprosyn ® ) 
 
 , Naprosyn ) oxaprozin (Daypro ® ) 
 
 ) piroxicam (Feldene ® ) 
 
 ) sulindac 
 
 tolmetin 
 
 salicylate 
 
 salsalate (Disalcid®) 
 
 How will my healthcare provider choose an NSAID that is right for me? 
 
 In planning your treatment, your healthcare provider will take into account the effectiveness and the risks of drugs. Your healthcare provider will work with you to develop an appropriate treatment program. The drugs that will be prescribed will match the seriousness of your condition. Your healthcare provider will consider the results of your medical history, physical exam, X-rays, blood tests, and the presence of other medical conditions in creating your treatment plan. 
 
 It is important to meet with your healthcare provider regularly so he or she can watch for any harmful side effects and change your treatment, if necessary. Your healthcare provider may order blood tests or other tests (including a kidney function test) from time to time to determine how effective your treatment is, and to look for any harmful side effects. 
 
 Are there specific warnings associated with NSAID use? 
 
 The Food and Drug Administration added new warnings about NSAIDs in July 2015. 
 
 NSAIDs can increase the chance of heart attack or stroke. This risk may be greater if you have heart disease or risk factors (for example, smoking, high blood pressure, high cholesterol, diabetes) for heart disease. However, the risk may also be increased in people who do not have heart disease or those risk factors. 
 
 Heart problems caused by NSAIDs can happen within the first weeks of use, and may happen more frequently with higher doses or with long-term use. 
 
 NSAIDs should not be used right before or after heart bypass surgery. 
 
 NSAIDs may increase the chance of serious stomach and bowel side effects like ulcers and bleeding. This risk may be greater in older individuals. These side effects can occur without warning signs. 
 
 What are some common side effects of NSAIDs? 
 
 Side effects may occur if you are taking large doses of NSAIDs, or if you are taking them for a long time. Some side effects are mild and go away, while others are more serious and need medical attention. 
 
 Please note: The side effects listed below are the most common. All possible side effects are not included. Always contact your healthcare provider if you have questions about your particular medication. 
 
 The most frequently reported side effects of NSAIDs are gastrointestinal symptoms, such as: 
 
 Gas 
 
 Feeling bloated 
 
 Heartburn 
 
 Stomach pain 
 
 Nausea 
 
 Vomiting 
 
 Diarrhea and/or constipation 
 
 These side effects can generally be relieved by taking the drug with adequate amounts of food. NSAIDs may also be taken with milk or antacids (such as Maalox® or Mylanta®) to prevent gastrointestinal symptoms. 
 
 If the symptoms continue, the NSAID may need to be stopped. You should contact your healthcare provider if the symptoms listed above do not stop after a few days of taking the NSAID with food, milk, or antacids. 
 
 Some other side effects of NSAIDs include: 
 
 Dizziness 
 
 Feeling lightheaded 
 
 Problems with balance 
 
 Difficulty concentrating 
 
 Mild headaches 
 
 If these symptoms continue for more than a few days, stop taking the NSAID and contact your healthcare provider for more instructions. 
 
 What side effects should I tell my healthcare provider about right away? 
 
 If you have any of the following side effects, it is important to call your healthcare provider right away. 
 
 Fluid retention (recognized by swelling of the mouth, face, lips or tongue, around the ankles, feet, lower legs, hands, and possibly around the eyes) 
 
 Ringing in the ears 
 
 Severe rash or hives or red, peeling skin 
 
 Itching 
 
 Unexplained bruising and bleeding 
 
 Unusual weight gain 
 
 Black stools – bloody or black, tarry stools 
 
 Bloody or cloudy urine 
 
 Severe stomach pain 
 
 Blood or material that looks like coffee grounds in vomit (bleeding may occur without warning symptoms like pain) 
 
 Blurred vision 
 
 Wheezing, trouble breathing, or unusual cough 
 
 Chest pain, rapid heartbeat, palpitations 
 
 Acute fatigue, flu-like symptoms 
 
 Jaundice 
 
 Photosensitivity (greater sensitivity to light) 
 
 Change in strength on one side is greater than the other, trouble speaking or thinking, change in balance 
 
 Inability to pass urine, or change in how much urine is passed 
 
 Very bad back pain 
 
 Very bad headache 
 
 Feeling very tired and weak 
 
 Can I take NSAIDs if I'm being treated for high blood pressure? 
 
 NSAIDs can raise blood pressure in some people. Some people with high blood pressure (hypertension) may have to stop taking NSAIDs, if they notice that their blood pressure increases even if they are taking their blood pressure medications and following their diet. If you are taking blood pressure medication, talk to your healthcare provider before taking NSAIDs. 
 
 Is there anyone who should not take NSAIDs? 
 
 People who have the following conditions or circumstances should not use any type of NSAID until they are first evaluated by their healthcare provider: 
 
 Children and teenagers with viral infections (with or without fever) should not receive aspirin or aspirin-containing products due to the risk of Reye's syndrome. 
 
 Those who have an upcoming surgical procedure, including dental surgery 
 
 Diabetes that is difficult to control 
 
 Known kidney disease 
 
 Known liver disease 
 
 Known allergies to medications, especially aspirin, other NSAIDs, and sulfa drugs 
 
 Nasal polyps (linked to a greater chance of NSAID allergy) 
 
 Active peptic ulcer disease (stomach ulcers or previous history of stomach ulcer bleeding) 
 
 Gastroesophageal reflux disease, also known as GERD 
 
 Crohn’s disease or ulcerative colitis 
 
 Bleeding problems (people who have a history of prolonged bleeding time or who bruise easily) 
 
 People who have three or more alcoholic beverages per day 
 
 High blood pressure that is difficult to control 
 
 Active congestive heart failure 
 
 Asthma that gets worse when taking aspirin 
 
 Pregnancy in the third trimester 
 
 History of stroke or heart attack 
 
 If you are 65 years of age or older 
 
 Simultaneous use with certain medications such as warfarin (Coumadin ® ), clopidogrel (Plavix), corticosteroids (for example, prednisone), phenytoin (Dilantin ® ), cyclosporine (Neoral ® , Sandimmune ® ), probenecid, lithium (Lithobid ® ) and drugs used for various disease states such as arthritis, diabetes, high blood pressure, heart disease, and vitamins and other dietary/herbal supplements 
 
 ), clopidogrel (Plavix), corticosteroids (for example, prednisone), phenytoin (Dilantin ), cyclosporine (Neoral , Sandimmune ), probenecid, lithium (Lithobid ) and drugs used for various disease states such as arthritis, diabetes, high blood pressure, heart disease, and vitamins and other dietary/herbal supplements Phenylketonuria (PKU). Some nonprescription NSAIDs are sweetened with aspartame, a source of phenylalanine. 
 
 Before you start taking over-the-counter NSAIDs, have your physician or pharmacist evaluate all of your current medications to see if there would be any potential interactions. 
 
 Can NSAIDs cause allergic reactions? 
 
 Very rarely, a nonsteroidal anti-inflammatory agent can cause a generalized allergic reaction known as anaphylactic shock. If this happens, it usually occurs soon after the person starts taking the NSAID. The symptoms of this reaction include: 
 
 Swollen eyes, lips, or tongue 
 
 Difficulty swallowing 
 
 Shortness of breath 
 
 Rapid heart rate 
 
 Chest pain 
 
 Decrease in sedation 
 
 If any of these symptoms occur, call 9-1-1 or have someone drive you to the nearest emergency room immediately. 
 
 Before medication is prescribed, tell your healthcare provider: 
 
 If you are allergic to any medications, foods, or other substances 
 
 If you are currently taking any other medications (including over-the-counter medications) and/or herbal or dietary supplements 
 
 If you are pregnant, planning to become pregnant, or are breast-feeding 
 
 If you have problems taking any medications 
 
 If you have anemia, kidney or liver disease, stomach or peptic ulcers, heart disease, high blood pressure, bleeding or clotting problems, asthma, or growth in the nose (nasal polyps) 
 
 Before you start taking any new medication, ask your healthcare provider: 
 
 What is the name of the medication? 
 
 Why do I need to take it? 
 
 How often should I take it? 
 
 What time of day should I take it? 
 
 Should I take it on an empty stomach or with meals? 
 
 Where should I store the medication? 
 
 What should I do if I forget to take a dose? 
 
 How long should I expect to take the medication? 
 
 How will I know it is working? 
 
 What side effects should I expect? 
 
 Will the medication interfere with driving, working, or other activities? 
 
 Does the medication interact with any foods, alcohol, or other medications (including over-the-counter medications, herbal and/or dietary supplements)? 
 
 This information is a summary only. It does not contain all information about this medicine. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other healthcare provider. 
 
 References 
 
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 Can't find the health information you’re looking for? 
 
 This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.This document was last reviewed on: 4/27/2016...#11086 ||||| 
 
 RALEIGH, N.C. (WNCN) – For the last several years, the FDA has warned that ibuprofen, Naproxen and other NSAID-type painkillers may cause an increased risk for heart disease and stroke. 
 
 Now the FDA has strengthened its warning for these drugs and says that these agents absolutely do raise the risk for heart attack and stroke. 
 
 The FDA said it reviewed a large number of studies that supported the conclusion that the medicines caused increased risk. The studies estimated that the relative risk increased by 10 percent to 50 percent, depending on the drugs and the doses considered. 
 
 The new FDA warning covers drugs called nonsteroidal anti-inflammatory drugs or NSAIDS for short. They include ibuprofen, sold under brand names like Advil or Motrin; naproxen (Aleve), as well as prescription arthritis drugs known as COX-2 inhibitors, such as Celebrex. 
 
 Ibuprofen and other NSAIDs work by inhibiting production of prostaglandins—(by inhibiting an enzyme called cyclooxygenase). Prostaglandins are chemicals released by injured cells that trigger inflammation and pain. It is important to remember that Tylenol, known generically as acetaminophen, is not an NSAID and works in a different way. It is not included in this new FDA warning. Tylenol also has potential health risks and this includes liver damage and toxicity when taken in very high doses. 
 
 Prescription NSAIDs are an important treatment for the symptoms of many debilitating conditions, including arthritis, rheumatoid arthritis‎, gout and other rheumatological conditions. 
 
 NSAIDs are used to temporarily reduce fever and to treat minor aches and pains such as headaches, toothaches, backaches, muscular aches, tendonitis, strains, sprains and menstrual cramps. 
 
 Remember that in addition, some combination medicines that relieve various symptoms, such as multi-symptom cold products, contain NSAIDs. 
 
 According to an FDA spokesman, the “FDA is strengthening an existing warning in prescription drug labels and over-the-counter (OTC) drug facts labels to indicate that non-steroidal anti-inflammatory drugs can increase the chance of a heart attack or stroke, either of which can lead to death.” 
 
 The FDA has carefully reviewed the data for the last year and has found that in numerous studies it has been clear that the use of NSAIDS is associated with an increased risk for heart disease and stroke. 
 
 Some of the studies they looked at showed a clear pattern: people who took NSAIDS were more likely to have heart attacks or strokes. Many of the researchers found that the time course of the development of heart disease can be both early and late in the course of starting NSAIDS. 
 
 The FDA added a boxed warning to prescription drug labels for the increased risk for heart disease and stroke in 2005. More recent data has now prompted the FDA to update NSAID labeling. 
 
 Today we know that the risk of heart attack and stroke may occur early in treatment, even in the first weeks. People who have cardiovascular disease, particularly those who recently had a heart attack or cardiac bypass surgery, are at the greatest risk for cardiovascular adverse events associated with NSAIDs. This particular population is at very high risk—they are quite vulnerable and should avoid NSAIDs when possible. 
 
 The bottom line is that NSAIDs are effective treatments for pain, inflammation and fever. 
 
 Consumers can still take them but should be aware of this increased risk of heart attack or stroke, especially at higher doses. 
 
 If you have heart disease or high blood pressure, talk with your doctor before using an NSAID. 
 
 Together, with your doctor, you must balance the benefits of NSAIDs with the possible risks. 
 
 Seek urgent medical attention and stop taking NSAIDs if you experience symptoms that might signal heart problems or stroke — chest pain, trouble breathing, sudden weakness in one part or side of the body, or sudden slurred speech. If you take these drugs, take the smallest effective dose. 
 
 To get in touch with Dr. Campbell, you can head to his website, Facebook page or message him on Twitter. ||||| Español 
 
 Subscribe: FDA Consumer Health Information 
 
 Next time you reach into the medicine cabinet seeking relief for a headache, backache or arthritis, be aware of important safety information for non-steroidal anti-inflammatory drugs. 
 
 FDA is strengthening an existing warning in prescription drug labels and over-the-counter (OTC) Drug Facts labels to indicate that nonsteroidal anti-inflammatory drugs (NSAIDs) can increase the chance of a heart attack or stroke, either of which can lead to death. Those serious side effects can occur as early as the first few weeks of using an NSAID, and the risk might rise the longer people take NSAIDs. (Although aspirin is also an NSAID, this revised warning doesn’t apply to aspirin.) 
 
 The OTC drugs in this group are used for the temporary relief of pain and fever. The prescription drugs in this group are used to treat several kinds of arthritis and other painful conditions. Because many prescription and OTC medicines contain NSAIDs, consumers should avoid taking multiple remedies with the same active ingredient. 
 
 The Risks and What’s New 
 
 Prescription NSAIDs are an important treatment for the symptoms of many debilitating conditions, including osteoarthritis, rheumatoid arthritis‎, gout and other rheumatological and painful conditions. OTC NSAIDs are used to temporarily reduce fever and to treat minor aches and pains such as headaches, toothaches, backaches, muscular aches, tendonitis, strains, sprains and menstrual cramps. Common OTC NSAIDs include ibuprofen (Motrin, Advil) and naproxen (Aleve). In addition, some combination medicines that relieve various symptoms, such as multi-symptom cold products, contain NSAIDs. 
 
 “Be careful not to take more than one product that contains an NSAID at a time,” says Karen M. Mahoney, M.D., deputy director of FDA’s Division of Nonprescription Drug Products. How will you know? Check the list of active ingredients in the Drug Facts label. 
 
 The labels for both prescription NSAIDs and OTC NSAIDs already have information on heart attack and stroke risk. In the coming months, FDA will require manufacturers of prescription NSAIDs to update their labels with more specific information about heart attack and stroke risks. FDA will also request that the manufacturers of OTC NSAIDs update the heart attack and stroke risk information in Drug Facts labels. 
 
 FDA added a boxed warning to prescription drug labels for this risk in 2005. More recent data and information are prompting FDA to update NSAID labeling. Today we know that the risk of heart attack and stroke may occur early in treatment, even in the first weeks. 
 
 “There is no period of use shown to be without risk,” says Judy Racoosin, M.D., M.P.H., deputy director of FDA’s Division of Anesthesia, Analgesia, and Addiction Products. 
 
 People who have cardiovascular disease, particularly those who recently had a heart attack or cardiac bypass surgery, are at the greatest risk for cardiovascular adverse events associated with NSAIDs. 
 
 FDA is adding information in the drug label for people who already have had a heart attack. This vulnerable population is at an increased risk of having another heart attack or dying of heart attack-related causes if they’re treated with NSAIDs, according to studies. 
 
 But the risk is also present in people without cardiovascular disease. “Everyone may be at risk – even people without an underlying risk for cardiovascular disease,” Racoosin adds. 
 
 What Consumers Should Do 
 
 NSAIDs are effective treatments for pain, inflammation and fever. Consumers can still take them but should be aware of this increased risk of heart attack or stroke, especially at higher doses. 
 
 “As always, consumers must carefully read the Drug Facts label for all nonprescription drugs. Consumers should carefully consider whether the drug is right for them, and use the medicine only as directed. Take the lowest effective dose for the shortest amount of time possible,” Mahoney says. 
 
 When using prescription NSAIDs, read the consumer-friendly Medication Guide attached to your filled prescription, which provides important safety information. 
 
 If you have heart disease or high blood pressure, consult a health care provider before using an NSAID. Balance the benefits of NSAIDs with the possible risks and weigh your options. If you take low-dose aspirin for protection against heart attack and stroke, you should know that some NSAIDs, including ibuprofen and naproxen, can interfere with that protective effect. 
 
 Stop taking NSAIDs and seek medical help if you experience symptoms that might signal heart problems or stroke, such as chest pain, trouble breathing, sudden weakness in one part or side of the body, or sudden slurred speech. 
 
 Reduce your risk factors for heart disease and stroke. “Smoking, high blood pressure, high cholesterol and diabetes are significant risk factors for these conditions,” Mahoney says. “If you smoke, work on quitting. See your doctor regularly to find out if you have these other strong risk factors, and commit yourself to taking care of them and of your health.” 
 
 July 9, 2015 
 
 back to top ||||| The U.S. Food and Drug Administration (FDA) is strengthening an existing label warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) increase the chance of a heart attack or stroke. Based on our comprehensive review of new safety information, we are requiring updates to the drug labels of all prescription NSAIDs. As is the case with current prescription NSAID labels, the Drug Facts labels of over-the-counter (OTC) non-aspirin NSAIDs already contain information on heart attack and stroke risk. We will also request updates to the OTC non-aspirin NSAID Drug Facts labels. 
 
 Patients taking NSAIDs should seek medical attention immediately if they experience symptoms such as chest pain, shortness of breath or trouble breathing, weakness in one part or side of their body, or slurred speech. 
 
 NSAIDs are widely used to treat pain and fever from many different long- and short-term medical conditions such as arthritis, menstrual cramps, headaches, colds, and the flu. NSAIDs are available by prescription and OTC. Examples of NSAIDs include ibuprofen, naproxen, diclofenac, and celecoxib (see Table 1 for a list of NSAIDs). 
 
 The risk of heart attack and stroke with NSAIDs, either of which can lead to death, was first described in 2005 in the Boxed Warning and Warnings and Precautions sections of the prescription drug labels. Since then, we have reviewed a variety of new safety information on prescription and OTC NSAIDs, including observational studies,1 a large combined analysis of clinical trials,2 and other scientific publications.1 These studies were also discussed at a joint meeting of the Arthritis Advisory Committee and Drug Safety and Risk Management Advisory Committee held on February 10-11, 2014. 
 
 Based on our review and the advisory committees’ recommendations, the prescription NSAID labels will be revised to reflect the following information: 
 
 The risk of heart attack or stroke can occur as early as the first weeks of using an NSAID. The risk may increase with longer use of the NSAID. 
 
 The risk appears greater at higher doses. 
 
 It was previously thought that all NSAIDs may have a similar risk. Newer information makes it less clear that the risk for heart attack or stroke is similar for all NSAIDs; however, this newer information is not sufficient for us to determine that the risk of any particular NSAID is definitely higher or lower than that of any other particular NSAID. 
 
 NSAIDs can increase the risk of heart attack or stroke in patients with or without heart disease or risk factors for heart disease. A large number of studies support this finding, with varying estimates of how much the risk is increased, depending on the drugs and the doses studied. 
 
 In general, patients with heart disease or risk factors for it have a greater likelihood of heart attack or stroke following NSAID use than patients without these risk factors because they have a higher risk at baseline. 
 
 Patients treated with NSAIDs following a first heart attack were more likely to die in the first year after the heart attack compared to patients who were not treated with NSAIDs after their first heart attack. 
 
 There is an increased risk of heart failure with NSAID use. 
 
 We will request similar updates to the existing heart attack and stroke risk information in the Drug Facts labels of OTC non-aspirin NSAIDs. 
 
 In addition, the format and language contained throughout the labels of prescription NSAIDs will be updated to reflect the newest information available about the NSAID class. 
 
 Patients and health care professionals should remain alert for heart-related side effects the entire time that NSAIDs are being taken. We urge you to report side effects involving NSAIDs to the FDA MedWatch program, using the information in the “Contact FDA” box at the bottom of the page.
– The FDA advised back in 2005 that non-aspirin nonsteroidal anti-inflammatory drugs, or NSAIDs, could up the risk of heart attack and stroke. But the agency is now boosting that warning, noting that drugs like ibuprofen (often sold under the Motrin IB brand), naproxen (Aleve), and celecoxib (Celebrex) may pose a risk even in small amounts and that these drugs should be used sparingly and for short periods, the New York Times reports. (Aspirin, although an NSAID, doesn't pose the same risk, the FDA notes.) Although an FDA review found that higher doses increased the risk of heart attack or stroke—and the risk may increase with length of use—"there is no period of use shown to be without risk," an FDA deputy director says. And while people with cardiovascular disease are more at risk for being adversely affected by NSAIDs, "everyone may be at risk—even people without an underlying risk for cardiovascular disease," the FDA rep says. NSAIDs decrease production of prostaglandins, chemicals spewed out after an injury that trigger inflammation, WNCN reports. Per the FDA review, over-the-counter NSAIDs could up the risk of heart attack and stroke by about 10%, low-dose prescription meds by 20%, and higher-dose prescription NSAIDs by 50%, with "significant variability" in each estimate, an Emory University medical professor tells the Times. One NSAID, Vioxx, was taken off shelves in 2004 after being linked to 140,000 heart attacks over a five-year period, Bloomberg notes. The director of Northwestern University's Center for Communication and Health says that "one of the underlying messages (is) there are no completely safe pain relievers, period." How to cut down on potential NSAID risks, per the Harvard Health Blog: Take the lowest dose that works, limit how long you take it, and never take more than one NSAID at once. (Meanwhile, Benadryl may up your risk for Alzheimer's.)