Anti-inflammatory medications - nonsteroidal anti-inflammatory drugs (NSAIDs)

Selected Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) include:

  • Diclofenac (Cataflam oral, Solaraze topical, Voltaren Ophthalmic, Voltaren oral, and Voltaren-XR oral)
  • Diflunisal (Dolobid)
  • Etodolac (Lodine and Lodine XL)
  • Fenoprofen (Nalfon)
  • Flurbiprofen (Ansaid, Ocufen)
  • Ibuprofen (Advil Migraine Liqui-Gels [OTC], Advil [OTC], Children's Advil Oral Suspension [OTC], Children's Motrin Oral Suspension[OTC], Genpril [OTC], Haltran[OTC], Junior Strength Motrin [OTC], Menadol [OTC], Midol IB [OTC], Motrin, Motrin IB [OTC], Motrin Migraine Pain [OTC], and Nuprin [OTC])
  • Indomethacin (Indocin)
  • Ketoprofen (Orudis and Oruvail)
  • Ketorolac (Acular,Acular LS, Acular PF, Acuvail, SPRIX)
  • Meclofenamate (Meclomen)
  • Mefenamic acid
  • Meloxicam
  • Nabumetone (Relafen)
  • Naproxen (Aleve [OTC], Anaprox, EC Naprosyn, Naprelan, and Naprosyn)
  • Oxaprozin (Daypro)
  • Piroxicam (Feldene)
  • Sulindac (Clinoril)
  • Tolmetin (Tolectin and Tolectin DS)

Depletions

Iron

Taking nonsteroidal anti-inflammatory drugs may deplete iron.

Your body needs iron for blood to carry oxygen to your organs and tissues.

Low levels of iron can cause anemia. Symptoms of anemia because of iron deficiency include:

  • Fatigue
  • Weakness
  • Dizziness
  • Lightheadedness
  • Shortness of breath
  • Pale skin
  • Irregular heartbeat

Low levels of iron may also cause:

  • Pain and swelling of the tongue
  • Weakened immune system
  • Poor growth
  • Reduced performance at work

Vitamin B9 (Folic Acid)

Taking sulindac may deplete vitamin B9.

Low levels of folic acid in the body may be linked to:

  • Anemia
  • Heart disease
  • Birth defects

Symptoms may include:

  • Weakness
  • Mouth sores
  • Swollen tongue
  • Depression
  • Poor growth

Vitamin C (Ascorbic Acid)

Taking diflunisal may deplete vitamin C.

Low levels of vitamin C in your body cause a condition called scurvy. Some common symptoms are:

  • Soft, bleeding gums
  • Injuries that are slow to heal
  • Weakened immune system
  • Fatigue
  • Weight loss
  • Loose teeth
  • Muscle weakness
  • Pain in bones and muscles
  • Anemia

Sodium

Taking nonsteroidal anti-inflammatory drugs except diflunisal may deplete sodium.

Sodium deficiency is rare because it is widely available in dietary sources. When it does occur, low levels have been associated with:

  • Weakness
  • Nausea and vomiting
  • Headache
  • Confusion
  • Memory impairment
  • Reduced attention
  • Muscle cramps
  • Strong, rapid or irregular heartbeat
  • Lack of energy
  • Restlessness

Severe cases can cause seizures, loss of consciousness, and possibly coma. The development of symptoms depends on how fast you lose sodium.

Editorial Note

The information presented here covers some of the nutrients that may be affected when you take certain medicines. If you have any of these signs and symptoms, it does not always mean you have low levels of these nutrients.

Factors that affect the level of nutrients are:

  • Your medical history
  • Diet
  • Lifestyle
  • How long you have been taking the medicine

Please talk to your health care provider. They can best address your health care needs and see if you are at risk for low levels of any nutrients.

Supporting Research

Asiedu DK. Vitamin deficiency (Hypovitaminosis). In: Ferri FF, ed. Ferri's Clinical Advisor 2017. Philadelphia, PA: Elsevier; 2017:1359-1360.

Cole JB, Roberts DJ. Cardiovascular drugs. In: Marx JA, Hockberger R, Walls R, eds. Rosen's Emergency Medicine. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 152.

Dineen R, Hannon MJ, Thompson CJ. Hyponatremia and hypernatremia. In: Jameson JL, De Groot LJ, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 112.

Dominiczak MH, Broom JI. Vitamins and minerals. In: Baynes JW, Dominiczak MH, eds. Medical Biochemistry. 4th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 11.

Ferri FF. Nutrional trace elements and their clinical impIications: Ferri FF, ed. Ferri's Clinical Advisor 2017. Philadelphia, PA: Elsevier; 2017:Appendix IIc, 1872-1874.

Gold Standard Drug Database. Drug Monograph: Fenoprofen. 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-244. Accessed July 8, 2016.

Gold Standard Drug Database. Drug Monograph: Flurbiprofen. 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-1347. Accessed July 14, 2016.

Gold Standard Drug Database. Drug Monograph: Indomethacin. 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-314. Accessed July 8, 2016.

Gold Standard Drug Database. Drug Monograph: Ketorolac. 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-336. Accessed July 14, 2016.

Gold Standard Drug Database. Drug Monograph: Meclofenamate. 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-3670. Accessed July 8, 2016.

Gold Standard Drug Database. Drug Monograph: Diclofenac. 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-183. Accessed July 8, 2016.

Gold Standard Drug Database. Drug Monograph: Diflunisal. 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-188. Accessed July 8, 2016.

Gold Standard Drug Database. Drug Monograph: Etodolac. 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-237. Accessed July 8, 2016.

Gold Standard Drug Database. Drug Monograph: Ibuprofen. 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-303. Accessed July 8, 2016.

Gold Standard Drug Database. Drug Monograph: Ketoprofen. 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-335. Accessed July 8, 2016.

Gold Standard Drug Database. Drug Monograph: Mefenamic acid. 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-3671. Accessed July 14, 2016.

Gold Standard Drug Database. Drug Monograph: Meloxicam. 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-755. Accessed July 14, 2016.

Gold Standard Drug Database. Drug Monograph: Nabumetone. 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-420. Accessed July 8, 2016.

Gold Standard Drug Database. Drug Monograph: Naproxen. 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-427. Accessed July 8, 2016.

Gold Standard Drug Database. Drug Monograph: Oxaprozin. 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-1486. Accessed July 8, 2016.

Gold Standard Drug Database. Drug Monograph: Piroxicam. 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-492. Accessed July 8, 2016.

Gold Standard Drug Database. Drug Monograph: Sulindac. 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-2509. Accessed July 8, 2016.

Gold Standard Drug Database. Drug Monograph: Tolmetin. 2016. www.clinicalkey.com/#!/content/drug_monograph/6-s2.0-619. Accessed July 8, 2016.

Sachdev HPS, Shah D. Vitamin B complex deficiencies and excess. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 49.

Shenkin A, Roberts NB. Vitamins and trace elements. In: Burtis CA, Ashwood ER, Bruns DE, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 5th ed. St. Louis, MO: Elsevier Saunders; 2012:chap 31.

Version Info

  • Last reviewed on 9/19/2016
  • Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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