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Nonsteroidal Anti-Inflammatory Drugs

Also indexed as: Dalfon, Diflunisal, Dolobid, Fenoprofen, Meclofenamate, Meclomen, Mefenamic Acid, Meloxicam, Mobic, Nonsteroidal Anti-Inflammatory Analgesics, NSAIDs, Ponstel, Tolectin, Tolmetin

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Nonsteroidal anti-inflammatory drugs (NSAIDs) are a family of medications used to treat rheumatoid arthritis, osteoarthritis, mild-to-moderate pain, menstrual cramps, bursitis, gout, and migraine headaches, as well as other conditions. Ophthalmic formulations of certain NSAIDs are used during or after eye surgery. NSAIDs are divided into two categories, based on their action within the body: COX-1 and COX-2 inhibitors.

Summary of Interactions with Vitamins, Herbs, and Foods
In some cases, a herb or supplement may appear in more than one category, which may seem contradictory. For clarification, read the full article for details about the summarized interactions.

Avoid Avoid: Adverse interaction—Avoid these supplements when taking this medication because taking them together may cause undesirable or dangerous results.

Lithium

White willow
Depletion or interference

None known
Side effect reduction/prevention

None known
Supportive interaction

None known
Reduced drug absorption/bioavailability

None known
Interactions common to many, if not all, NSAIDs are described in this article. Interactions reported for only one or a few drugs in this class may not be listed in this article. Some drugs listed in this article are linked to articles specific to that respective drug; please refer to those individual drug articles. The information in this article may not necessarily apply to drugs in this class for which no separate article exists. If you are taking an NSAID for which no separate article exists, talk with your doctor or chemist.

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions involving oral NSAIDs in general are described on this page. For interactions involving specific NSAIDs, refer to the highlighted drugs listed below.

COX-1 Inhibitors

COX-2 Inhibitors

  • Celecoxib (Celebrex®)
  • Valdecoxib (Bextra®)

Interactions with Dietary Supplements

Lithium
Lithium is a mineral that may be present in some supplements and is also used in large amounts to treat mood disorders such as manic-depression (bipolar disorder). Most NSAIDs inhibit the excretion of lithium from the body, resulting in higher blood levels of the mineral, though sulindac may have an opposite effect.1 Since major changes in lithium blood levels can produce unwanted side effects or interfere with its efficacy, NSAIDs should be used with caution, and only under medical supervision, in people taking lithium supplements.

Interactions with Herbs

White willow bark (Salix alba)
White willow bark contains salicin, which is related to aspirin. Both salicin and aspirin produce anti-inflammatory effects after they have been converted to salicylic acid in the body. The administration of salicylates like aspirin to individuals taking oral NSAIDs may result in reduced blood levels of NSAIDs.2 Though no studies have investigated interactions between white willow bark and NSAIDs, people taking NSAIDs should avoid the herb until more information is available.

References

1. Olin BR, ed. Central Nervous System Drugs, Analgesics and Anti-inflammatory Drugs, Nonsteroidal Anti-inflammatory Agents, In Drug Facts and Comparisons. St. Louis, MO: Facts and Comparisons, 1993, 1172–90.

2. Olin BR, ed. Central Nervous System Drugs, Analgesics and Anti-inflammatory Drugs, Nonsteroidal Anti-inflammatory Agents, In Drug Facts and Comparisons. St. Louis, MO: Facts and Comparisons, 1993, 1172–90.