Psoriatic Arthritis treatments: Non-steroidal anti-inflammatory drugs (NSAIDS)

Aceclofenac belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It is used to relieve pain and inflammation associated with osteoarthritis, rheumatoid arthritis and ankylosing spondylitis.

Aceclofenac helps control symptoms such as pain, swelling and stiffness, but unlike disease-modifying antirheumatic drugs (DMARDs), it does not alter the underlying disease process.

How does it work?

Aceclofenac works by reducing the production of substances called prostaglandins, which are involved in pain, swelling and inflammation.

It does this by blocking enzymes called cyclo-oxygenases (COX), which are involved in prostaglandin production.

Aceclofenac can reduce pain and inflammation, but it does not suppress the immune system or slow the progression of arthritis.

As with other NSAIDs, it should generally be used at the lowest effective dose for the shortest time necessary to control symptoms.

Who can get it?

Aceclofenac is a prescription-only medicine (POM).

It is not recommended for children because there is not enough information about its use in this age group.

Aceclofenac may not be suitable for people who:

• have had an allergic reaction to aspirin or another NSAID, such as ibuprofen, naproxen or diclofenac
• have or have had stomach or intestinal ulcers or bleeding
• have severe kidney or liver problems
• have certain heart or circulation problems
• have certain types of heart failure
• have a bleeding disorder
• are pregnant or breastfeeding, unless specifically advised by a doctor.

People with asthma, high blood pressure, kidney, liver or heart problems may need particular caution and monitoring.

How is it used?

The usual adult dose is 200 mg a day, taken as:

• 100 mg in the morning
• 100 mg in the evening.

The dose may need to be reduced in people with certain liver problems.

Aceclofenac tablets should be:

• swallowed whole with plenty of water
• taken preferably with or after food
• taken exactly as prescribed.

Do not take more than the prescribed dose.

Do not take aceclofenac together with another NSAID, including ibuprofen, naproxen, diclofenac or aspirin used as an anti-inflammatory, unless specifically advised by a healthcare professional. Taking more than one NSAID increases the risk of side effects, including stomach bleeding.

What are the side effects?

Not everyone will experience side effects.

Common side effects include:

• indigestion, stomach pain or other stomach and bowel problems
• nausea or diarrhoea
• dizziness
• headache
• increased liver enzymes shown by blood tests.

Other possible side effects include:

• vomiting or constipation
• wind
• mouth ulcers
• skin rash or itching
• increased blood pressure
• changes in kidney-function blood tests
• changes in blood-cell counts
• fluid retention and swelling.

Important safety information

Like other NSAIDs, aceclofenac can occasionally cause serious problems affecting the stomach, kidneys, liver, heart or circulation.

Stomach or intestinal ulcers, bleeding or perforation can occur, sometimes without warning. The risk is higher in older people and in those with a previous history of ulcers or gastrointestinal bleeding.

Seek urgent medical advice if you develop:

• black, tar-like stools
• vomiting blood or material that looks like coffee grounds
• severe or persistent stomach pain
• difficulty breathing or swelling of the face, lips or throat
• a severe skin reaction, blistering or peeling
• yellowing of the skin or eyes
• a significant reduction in urine or new swelling of the ankles, feet or hands.

Aceclofenac can also cause fluid retention and may increase cardiovascular risk, particularly with higher doses and longer-term treatment. People with cardiovascular risk factors should discuss the benefits and risks with their doctor.

Pregnancy and breastfeeding

Aceclofenac should generally be avoided during pregnancy and breastfeeding unless specifically considered essential by a doctor.

It must not be used during the third trimester of pregnancy because NSAIDs can cause serious problems for the unborn baby and can affect labour. Use from around 20 weeks of pregnancy can also affect the baby's kidneys and the amount of amniotic fluid.

NSAIDs may also make it more difficult for some women to become pregnant.

How do I get it?

Aceclofenac is available on prescription from a doctor or other authorised prescriber.

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Aceclofenac is available on prescription. Aceclofenac is known commercially as Preservex and is marketed in the UK by Almirall Ltd

Reviewed: September 2026
Version ID: 2/ACE/PAT/09/26

Arthrotec is a combination medicine containing two active ingredients: diclofenac sodium and misoprostol.

Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) used to relieve pain and inflammation associated with osteoarthritis and rheumatoid arthritis.

Misoprostol helps protect the stomach and upper intestine from some of the ulcer-related effects of diclofenac.

Arthrotec is particularly useful for people who need diclofenac but are at increased risk of developing an NSAID-related stomach or duodenal ulcer.

How does it work?

Diclofenac reduces the production of substances called prostaglandins, which are involved in pain, swelling and inflammation. This helps reduce the symptoms of arthritis.

However, prostaglandins also have an important protective effect on the lining of the stomach and intestine. Reducing them with an NSAID can increase the risk of stomach or intestinal ulcers and bleeding.

Misoprostol is a synthetic form of a prostaglandin. It helps protect the stomach and intestine by supporting the natural protective mechanisms of the digestive system.

The two medicines are combined in Arthrotec so that the anti-inflammatory and pain-relieving effects of diclofenac are provided alongside protection against NSAID-related gastric and duodenal ulceration. Misoprostol does not completely remove the risk of ulcers or bleeding.

Who can get it?

Arthrotec is intended for adults. Its safety and effectiveness in children under 18 have not been established.

It may be prescribed when diclofenac is needed and there is a particular need to reduce the risk of NSAID-related stomach or duodenal ulcers.

Arthrotec should not be taken by people who have:

• an allergy to diclofenac, aspirin, other NSAIDs or misoprostol
• had asthma, hives or other allergic reactions triggered by aspirin or another NSAID
• an active stomach or intestinal ulcer or bleeding
• certain serious heart, kidney or liver problems.

Pregnancy and contraception

Arthrotec must not be taken during pregnancy or when planning a pregnancy.

Misoprostol can cause miscarriage, premature labour and birth defects. Women who could become pregnant should use effective contraception while taking Arthrotec.

If you think you may be pregnant while taking Arthrotec, stop taking it and contact your doctor promptly.

How is it used?

Arthrotec is available in two strengths:

• Arthrotec 50 – 50 mg diclofenac sodium and 200 micrograms misoprostol per tablet
• Arthrotec 75 – 75 mg diclofenac sodium and 200 micrograms misoprostol per tablet.

The dose depends on the strength prescribed:

• Arthrotec 50 is usually taken one tablet two or three times a day.
• Arthrotec 75 is usually taken one tablet twice a day.

Take Arthrotec with food.

Swallow the tablets whole with a drink of water. Do not chew them, as this can affect the way the medicine is released and may increase the risk of stomach irritation.

Use the lowest effective dose for the shortest time necessary to control symptoms.

Do not take Arthrotec with another NSAID, such as ibuprofen, naproxen or diclofenac, unless specifically advised by a healthcare professional.

What are the side effects?

Not everyone experiences side effects.

The most common side effects are related to the digestive system and include:

• diarrhoea
• stomach pain or discomfort
• nausea or vomiting
• indigestion
• constipation

Other possible side effects include:

• headache
• dizziness
• tiredness
• skin rash or itching
• changes in liver-function blood tests
• changes in kidney function
• fluid retention and swelling
• changes in blood-cell counts.

Misoprostol can cause diarrhoea and abdominal cramping, particularly when treatment is first started.

Important safety information

Like other NSAIDs, diclofenac can occasionally cause serious problems including stomach or intestinal ulcers, bleeding or perforation, even in people who have not previously had stomach problems.

Seek urgent medical attention if you develop:

• black or bloody stools
• vomiting blood or material that looks like coffee grounds
• severe or persistent stomach pain
• difficulty breathing or swelling of the face, lips, mouth or throat
• a severe skin reaction, blistering or peeling
• yellowing of the skin or eyes
• a significant reduction in urine or new swelling of the feet or ankles.

Long-term treatment may require monitoring of kidney function, liver function and blood counts, particularly in people who have other health conditions or risk factors.

Arthrotec can also cause dizziness or other effects that may affect your ability to drive or operate machinery. Do not drive or use machinery if you feel affected.

How do I get it?

Arthrotec is a prescription-only medicine (POM) and is available from pharmacies on prescription.

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Arthrotec is marketed in the UK by Pfizer Ltd

Reviewed: September 2026
Version ID: 2/ART/PAT/09/26

Aspirin belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It can be used to relieve pain, reduce fever and inflammation, including inflammation associated with rheumatic conditions.

Aspirin is also used at much lower doses to reduce the risk of blood clots in some people. This is a different use from taking aspirin for pain and inflammation.

How does it work?

Aspirin works by blocking enzymes called cyclo-oxygenase (COX). These enzymes are involved in the production of substances called prostaglandins, which contribute to pain, inflammation and fever.

By reducing the production of prostaglandins, higher doses of aspirin can help to relieve pain and reduce inflammation.

Aspirin also affects platelets in the blood, making them less likely to stick together. This is why low-dose aspirin is sometimes prescribed to help prevent blood clots.

Who can have it?

Aspirin can be used by adults and young people aged 16 years and over when appropriate.

Children under 16 should not normally be given aspirin unless it has been specifically advised by a doctor. This is because aspirin use in children has been associated with a rare but serious condition called Reye's syndrome, which affects the liver and brain.

Aspirin may not be suitable for people with a history of stomach ulcers or bleeding, certain types of asthma, bleeding disorders, or severe kidney, liver or heart problems.

How is it used?

The dose depends on why aspirin is being used and the particular product.

For pain and inflammation, adults may be advised to take 300–900 mg at a time, repeated according to the instructions for the product. The maximum daily dose for some preparations is 4 g.

The lowest effective dose should be used for the shortest time necessary.

Aspirin should be taken exactly as directed by your doctor, pharmacist or the instructions on the packaging.

What are the side effects?

Medicines and their possible side effects can affect individuals in different ways. The following are some of the side effects that may be associated with aspirin. Because a side effect is stated here, it does not mean that everyone taking aspirin will experience it.

• Indigestion, stomach discomfort, nausea or vomiting
• Stomach or intestinal ulcers and bleeding
• Increased tendency to bleed
• Ringing or other noises in the ears (tinnitus), particularly with higher doses
• Allergic reactions such as skin rash, swelling or breathing difficulties
• Worsening of asthma in people who are sensitive to aspirin or other NSAIDs
• Changes in blood-cell counts
• Kidney or liver problems.

Seek urgent medical advice if you develop signs of serious bleeding, such as vomiting blood or passing black or bloody stools, or if you develop a serious allergic reaction.

Taking aspirin with other medicines

Aspirin can interact with a number of medicines.

Taking aspirin with other NSAIDs, such as ibuprofen, naproxen or diclofenac, can increase the risk of side effects, particularly stomach ulcers and bleeding. They should not normally be taken together unless advised by a doctor.

Aspirin can interact with methotrexate and may increase the risk of methotrexate side effects. If you take methotrexate, check with your doctor or pharmacist before taking aspirin regularly.

There may also be an increased risk of stomach ulcers and bleeding when aspirin is taken with corticosteroids such as prednisolone or dexamethasone.

Always tell your doctor or pharmacist about any other medicines you are taking, including medicines bought without a prescription.

How do I get Aspirin?

Aspirin is available from pharmacies and other retailers in a number of preparations and strengths. Some preparations are available without a prescription, while others are prescribed for specific medical conditions.

If you need to take aspirin regularly for pain or inflammation, speak to your doctor or pharmacist to make sure it is still the most appropriate treatment.

Reviewed: September 2026
Version ID: 2/ASP/PAT/09/26

This page is for reference only as this product is now discontinued

Axorid modified release capsules contain the active ingredient ketoprofen, which is a type of medicine called a non-steroidal anti-inflammatory drug (NSAIDs) and is used to treat pain caused by rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis in patients with a previous history or who are at risk of developing NSAID associated gastric ulcers and duodenal ulcers.

How does it work?

Axorid includes a sustained release form of ketoprofen and a gastroresistant form of omeprazole, both suitable for once daily administration which works by blocking the action of a substance in the body called cyclo-oxygenase (COX). Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced by the body in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. Ketoprofen blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.

Ketocid modified release capsules are designed to release the ketoprofen slowly and continuously over several hours. This provides prolonged pain relief, so these capsules are taken once a day. The capsules must be swallowed whole to avoid damaging the modified release action.

Who can get it?

It is available on prescription for adults and children over the age of 15.

How is it used?

Take one tablet daily with or just after food. It is also recommend that a proton pump inhibitor should be also used in patients with rheumatoid arthritis or osteoarthritis

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• GI intolerance,
• ulcerative stomatitis,
• CNS effects,
• malaise,
• fatigue,
• paraesthesia,
• hypersensitivity reactions,
• nephrotoxicity,
• abnormal liver function,
• neurological and haematological reactions.

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Axorid wasmarketed in the UK by and is marketed in the UK by Meda Pharmaceuticals Ltd

Brufen contains the active ingredient ibuprofen, which is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID). Ibuprofen is used to relieve pain, inflammation and fever. It can be used to relieve symptoms associated with rheumatoid arthritis, juvenile rheumatoid arthritis, ankylosing spondylitis, osteoarthritis and other inflammatory or musculoskeletal conditions. It can also be used for mild to moderate pain, including headaches, migraine, dental pain, period pain and pain following injury or surgery.

How does it work?

Ibuprofen works by blocking enzymes called cyclo-oxygenase (COX). These enzymes are involved in producing substances called prostaglandins, which contribute to pain, swelling, inflammation and fever.

By reducing the production of prostaglandins, ibuprofen helps reduce pain and inflammation and can also lower a high temperature.

Ibuprofen is used to relieve symptoms. It does not treat the underlying cause of inflammatory arthritis and is not a disease-modifying antirheumatic drug (DMARD).

Brufen Retard tablets are sustained-release tablets designed to release ibuprofen gradually over several hours. They should be swallowed whole and must not be chewed, crushed or broken. Brufen should preferably be taken with or after food, particularly if it causes stomach irritation.

Who can get it?

Brufen is available on prescription for adults and children when appropriate. The age and weight restrictions depend on the particular ibuprofen preparation.

Brufen Retard is recommended for adults and children over 12 years of age.

Ibuprofen may not be suitable for people with a history of stomach ulcers or bleeding, certain heart, kidney or liver problems, asthma triggered by NSAIDs, or certain blood-clotting problems. It should also be avoided during pregnancy unless specifically advised by a healthcare professional.

How is it used?

The dose depends on the preparation and the condition being treated.

For Brufen 400 mg tablets, the usual dose for rheumatic conditions in adults is 1,200–1,800 mg a day in divided doses. In severe or acute conditions, the dose may temporarily be increased, up to a maximum of 2,400 mg a day.

For Brufen Retard 800 mg tablets, the usual dose for adults and children over 12 is two tablets as a single daily dose, preferably in the early evening. In severe or acute conditions, three tablets a day may be used in two divided doses.

The lowest effective dose should be used for the shortest time necessary to control symptoms.

Do not take ibuprofen at the same time as another NSAID, such as naproxen, diclofenac or aspirin, unless advised by a healthcare professional.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the more common side effects associated with ibuprofen. Because a side effect is stated here, it does not mean that everyone using the medicine will experience it.

• Indigestion, stomach pain, nausea or vomiting
• Diarrhoea or constipation
• Headache or dizziness
• Skin rash
• Changes in liver or kidney function
• Changes in blood counts

More serious side effects can include stomach ulcers or bleeding, kidney problems or a serious allergic reaction. The risk can be higher with higher doses or longer-term treatment.

Seek medical advice urgently if you develop severe stomach pain, vomit blood, pass black stools, have difficulty breathing, or develop swelling of the face, mouth or throat.

Please read the patient information leaflet for further details.

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Brufen and Brufen Retard are marketed in the UK by Viatris. Other ibuprofen products and unbranded versions are also available.

Reviewed: September 2026
Version ID: 2/BRU/PAT/09/26

Celecoxib is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID). It is a selective cyclo-oxygenase-2 (COX-2) inhibitor and is used to relieve pain, stiffness and inflammation associated with osteoarthritis, rheumatoid arthritis and ankylosing spondylitis.

Celecoxib is used to relieve symptoms. It does not treat the underlying cause of inflammatory arthritis and is not a disease-modifying antirheumatic drug (DMARD).

Celecoxib can start to relieve pain relatively quickly, although improvement in inflammation and stiffness may take longer.

How does it work?

Celecoxib works by blocking an enzyme called cyclo-oxygenase-2 (COX-2). COX-2 is involved in producing substances called prostaglandins, which contribute to pain, swelling, inflammation and fever.

By reducing the production of these prostaglandins, celecoxib helps reduce pain and inflammation and can improve movement in conditions affecting the joints and muscles.

Celecoxib is designed to selectively block COX-2 rather than COX-1. However, like other NSAIDs, it can still cause stomach, kidney and cardiovascular side effects.

Who can get it?

Celecoxib is available on prescription for adults with osteoarthritis, rheumatoid arthritis or ankylosing spondylitis.

Your doctor will need to consider whether celecoxib is suitable if you:

• have had a stomach or intestinal ulcer or bleeding
• have heart or circulation problems, high blood pressure or other cardiovascular risk factors
• have kidney or liver problems
• have inflammatory bowel disease
• have asthma or an allergic reaction caused by aspirin or other NSAIDs
• are taking other medicines that may interact with celecoxib
• are pregnant, planning a pregnancy or could become pregnant.

Celecoxib is not normally recommended during pregnancy, particularly later in pregnancy. Your doctor will assess the risks and benefits before prescribing it.

How is it used?

Celecoxib capsules should be swallowed whole with a glass of water. They can be taken with or without food.

For osteoarthritis, the usual dose is 200 mg a day, taken either once daily or as two 100 mg doses.

For rheumatoid arthritis, the usual starting dose is 200 mg a day, divided into two doses.

For ankylosing spondylitis, the usual dose is 200 mg a day, taken once daily or in two divided doses.

The maximum recommended daily dose is 400 mg. The lowest effective dose should be used for the shortest possible time, and treatment should be reviewed regularly.

Do not take celecoxib together with another NSAID, such as ibuprofen, naproxen or diclofenac, unless specifically advised by a healthcare professional.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects associated with celecoxib. Because a side effect is stated here, it does not mean that everyone using the medicine will experience it.

• Indigestion, stomach pain, diarrhoea or nausea
• Flatulence
• Dizziness or headache
• Fluid retention or swelling of the legs and feet
• Skin rash or other allergic reactions
• Raised blood pressure
• Changes in kidney or liver function
• Infections such as upper respiratory tract infections

Like other NSAIDs, celecoxib can occasionally cause stomach ulcers or bleeding, kidney problems, serious allergic reactions and cardiovascular problems, including heart attack or stroke. The risk can increase with higher doses and longer treatment.

Seek medical advice urgently if you develop severe stomach pain, vomit blood, pass black stools, have difficulty breathing, develop swelling of the face or throat, or experience chest pain or sudden weakness.

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Celecoxib is known commercially as Celebrex and is marketed in the UK by Viatris.

Reviewed: September 2026
Version ID: 2/CEL/PAT/09/26

Dexibuprofen is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID). It is used to relieve pain and inflammation associated with osteoarthritis and other musculoskeletal conditions. It can also be used for mild to moderate pain, period pain and, in some circumstances, rheumatoid arthritis when longer-term disease-modifying treatment is not being considered.

Dexibuprofen is used to relieve symptoms. It does not treat the underlying cause of inflammatory arthritis and is not a disease-modifying antirheumatic drug (DMARD).

How does it work?

Dexibuprofen works by blocking enzymes involved in the production of substances called prostaglandins. Prostaglandins contribute to pain, swelling, inflammation and fever.

By reducing prostaglandin production, dexibuprofen helps reduce pain and inflammation and can improve movement in conditions affecting the joints and muscles.

Dexibuprofen is the pharmacologically active form (enantiomer) of ibuprofen. It has pain-relieving and anti-inflammatory effects similar to those of ibuprofen.

Who can get it?

Dexibuprofen is available on prescription for adults and children and adolescents from 8 years of age, although the strength and dose depend on age and body weight. Dexibuprofen 300 mg tablets are not suitable for children and adolescents.

Dexibuprofen may not be suitable if you:

• have had an allergic reaction to dexibuprofen, ibuprofen, aspirin or another NSAID
• have or have had a stomach or intestinal ulcer or bleeding
• have a bleeding disorder
• have severe heart, kidney or liver problems
• have active Crohn's disease or ulcerative colitis
• are taking anticoagulants or certain other medicines
• have asthma that is triggered by aspirin or other NSAIDs.

NSAIDs should be used with particular caution in older people and in people with heart, kidney or liver problems.

Dexibuprofen should not be used during the last three months of pregnancy. It should generally be avoided earlier in pregnancy unless specifically advised by a healthcare professional.

How is it used?

The dose depends on the condition being treated and the individual patient.

For osteoarthritis and rheumatoid arthritis, the recommended dose is usually 600–900 mg a day, divided into up to three doses. In acute conditions, the dose may be increased to a maximum of 1,200 mg a day.

For mild to moderate pain, the usual dose is 600 mg a day, divided into up to three doses. In acute pain, the dose may temporarily be increased to 1,200 mg a day.

The maximum single dose is 400 mg and the maximum daily dose is 1,200 mg. The lowest effective dose should be used for the shortest time necessary to control symptoms.

Children and adolescents should only receive dexibuprofen for a short time and at the lowest effective dose appropriate for their age and weight.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects associated with dexibuprofen. Because a side effect is stated here, it does not mean that everyone using the medicine will experience it.

• Indigestion or stomach pain
• Nausea, vomiting or diarrhoea
• Headache or dizziness
• Tiredness or drowsiness
• Skin rash
• Fluid retention or swelling
• Changes in kidney or liver function.

More serious side effects can include stomach ulcers or bleeding, kidney problems, serious allergic reactions and cardiovascular problems, including heart attack or stroke. The risk can increase with higher doses and longer treatment.

Seek medical advice urgently if you develop severe stomach pain, vomit blood, pass black stools, have difficulty breathing, develop swelling of the face or throat, or experience chest pain.

Do not take dexibuprofen together with another NSAID, such as ibuprofen, naproxen or diclofenac, unless specifically advised by a healthcare professional.

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Dexibuprofen is available on prescription and is commercially known as Seractil and is marketed in the UK Strides Pharma UK Ltd.

Reviewed: September 2026
Version ID: 2/DEX/PAT/09/26

Dexketoprofen belongs to a group of medicines known as non-steroidal anti-inflammatory drugs (NSAIDs).

Dexketoprofen is used for the short-term relief of mild to moderate pain, including musculoskeletal pain, painful periods (dysmenorrhoea) and dental pain.

It helps relieve pain and inflammation but does not treat the underlying cause of a rheumatic condition.

How does it work?

Dexketoprofen works by reducing the production of prostaglandins. These are chemicals involved in pain and inflammation. By reducing their production, dexketoprofen can help relieve pain, swelling and inflammation.

Who can get it?

Dexketoprofen is prescribed for adults. It is not recommended for children and adolescents under 18 years of age.

Your doctor may need to take particular care if you:

• have kidney, liver or heart problems, high blood pressure or fluid retention
• have asthma or have previously had an allergic reaction to aspirin or another NSAID
• have, or have previously had, a stomach or bowel ulcer, bleeding or other digestive problems
• have Crohn’s disease or ulcerative colitis
• have a blood-clotting or bleeding disorder
• are elderly, as you may be more likely to experience side effects
• are dehydrated because of vomiting, diarrhoea or not drinking enough fluids
• are taking other medicines, including those bought without a prescription, herbal or complementary medicines

Tell your doctor if you are pregnant, trying to become pregnant or breast-feeding. Dexketoprofen must not be used during the last three months of pregnancy or while breast-feeding. It is not recommended when trying to conceive or during investigations for infertility.

How is it used?

The usual dose is 12.5 mg every 4–6 hours or 25 mg every 8 hours.

The maximum daily dose is 75 mg.

Older people and those with mild kidney or liver problems should usually start with a lower maximum daily dose of 50 mg.

Dexketoprofen should be taken at the lowest effective dose for the shortest time necessary. It is intended for short-term use only.

Taking it with food can reduce the risk of stomach or bowel side effects. If you have acute pain and need quicker relief, your doctor or pharmacist may advise taking it at least 30 minutes before food.

Do not take dexketoprofen with other NSAIDs unless specifically advised by your doctor.

What are the side effects?

The most common side effects include:

• nausea, vomiting, indigestion or stomach pain
• diarrhoea
• dizziness or drowsiness
• headache

Less commonly, dexketoprofen can cause stomach or bowel ulcers or bleeding, fluid retention, increased blood pressure, or changes in kidney or liver function.

Seek medical attention if you develop severe stomach pain, vomit blood, pass black stools, have difficulty breathing or swelling of the face or throat, or develop a severe skin reaction.

NSAIDs such as dexketoprofen can slightly increase the risk of heart attack or stroke, particularly with higher doses or prolonged treatment.

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Dexketoprofen is available in the UK as Keral 25 mg film-coated tablets and is marketed by A. Menarini Farmaceutica Internazionale SRL.

Reviewed: September 2026
Version ID: 2/DET/PAT/09/26

Diclomax SR capsules and Diclomax Retard capsules contain the active ingredient diclofenac sodium, which is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID).

Diclofenac is used to relieve pain and inflammation in conditions such as rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, acute gout, back pain and a range of musculoskeletal problems, including sprains, strains, tendinitis, bursitis and frozen shoulder. It can also be used for pain and inflammation following some types of surgery.

Diclofenac helps relieve pain and inflammation but does not treat the underlying cause of a rheumatic condition and is not a disease-modifying treatment.

How does it work?

Diclofenac works by reducing the production of prostaglandins. These are chemicals involved in pain, swelling and inflammation.

Diclofenac blocks an enzyme called cyclo-oxygenase (COX), which is involved in the production of prostaglandins. This reduces pain and inflammation.

Diclomax SR and Diclomax Retard are modified-release capsules. They release diclofenac gradually, providing longer-lasting pain relief.

The capsules should be swallowed whole and should not be opened, chewed or crushed.

Who can get it?

Diclomax is available on prescription for adults. It is not recommended for children.

Particular care is needed if you:

• have had a stomach or intestinal ulcer, bleeding or perforation
• have asthma or have previously had an allergic reaction to aspirin or another NSAID
• have heart or circulation problems, high blood pressure, or risk factors for cardiovascular disease
• have kidney or liver problems
• have Crohn’s disease or ulcerative colitis
• have a blood-clotting or bleeding disorder
• are elderly, as the risk of serious side effects can be greater
• are taking other medicines, including other NSAIDs, aspirin, blood thinners, corticosteroids, some antidepressants or medicines for blood pressure

Diclofenac may increase the risk of heart attack or stroke, particularly with higher doses and longer treatment. Your doctor will consider your individual risk before prescribing it.

Tell your doctor if you are pregnant, trying to become pregnant or breast-feeding. Diclofenac should not be used during the last three months of pregnancy.

How is Diclomax taken?

Diclomax SR 75 mg

Adults: One or two 75 mg capsules daily, taken as a single dose or in divided doses.

Diclomax Retard 100 mg

Adults: One 100 mg capsule daily.

Both preparations should be taken whole, preferably with or after food.

The lowest effective dose should be used for the shortest time necessary to control symptoms. The maximum recommended daily dose of diclofenac is 150 mg.

Your doctor may prescribe a proton pump inhibitor (PPI), such as omeprazole, to help protect the stomach, particularly if you have an increased risk of stomach or intestinal problems.

Do not take Diclomax with other NSAIDs unless specifically advised by your doctor.

What are the side effects?

The most common side effects include:

• indigestion, stomach pain, nausea or vomiting
• diarrhoea or constipation
• excess gas (flatulence)
• loss of appetite
• headache
• dizziness or drowsiness
• skin rash

Diclofenac can sometimes cause stomach or intestinal ulcers or bleeding. It can also cause fluid retention, increased blood pressure, and changes in kidney or liver function.

Rarely, serious allergic reactions can occur, including swelling of the face, lips, tongue or throat and difficulty breathing.

Seek urgent medical attention if you vomit blood, pass black or bloody stools, develop severe stomach pain, have difficulty breathing or swelling of the face or throat, or develop a severe skin reaction.

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Diclomax is marketed in the UK by Galen Ltd.

Reviewed: September 2026
Version ID: 2/DIC/PAT/09/26

Difflam 3% Cream contains the active ingredient benzydamine hydrochloride, which belongs to a group of medicines known as non-steroidal anti-inflammatory drugs (NSAIDs).

Difflam Cream is a topical treatment used for the short-term relief of pain and inflammation associated with sprains, strains, bruises, sore muscles and stiff joints.

How does it work?

Benzydamine works locally to reduce pain and inflammation. It reduces the production and activity of substances involved in inflammation, helping to relieve pain, swelling and tenderness.

Benzydamine also has a local anaesthetic effect, which can cause temporary numbness and provide additional pain relief at the site where the cream is applied.

Who can get it?

Difflam 3% Cream is available without a prescription for adults and children, although children should use it only as advised by a pharmacist or healthcare professional.

Do not use Difflam Cream if you are allergic to benzydamine or any of the other ingredients.

Take care when using the cream if you have previously had an allergic reaction to NSAIDs.

How is it used?

The amount of cream needed depends on the size of the area being treated. Usually, between half and one full finger-length of cream is gently rubbed into the affected area.

The cream can normally be applied three times a day.

Rub the cream gently into the affected area until it disappears.

Do not use the cream in or near the eyes, mouth, nose or genital or anal areas. Wash the area with cold water if the cream accidentally comes into contact with these areas.

Difflam Cream is intended for short-term use. If your symptoms get worse or do not improve, speak to a doctor or pharmacist.

What are the side effects?

Like all medicines, Difflam Cream can cause side effects, although not everybody will experience them.

Possible side effects include:

• itching or skin irritation
• skin redness or rash
• burning, stinging or temporary numbness where the cream is applied
• allergic reactions such as swelling or difficulty breathing

Stop using the cream and seek medical advice if you develop a severe skin reaction or signs of an allergic reaction.

Some ingredients in the cream can cause skin irritation or allergic reactions.

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Difflam is marketed in the UK by Viatris UK Healthcare Ltd 

Review date: September 2026
Version ID: 2/DIF/PAT/09/26

Eccoxolac contains the active ingredient etodolac which is a type of medicine known as a non-steroidal anti-inflammatory drug (NSAID) used to relieve pain and inflammation as seen in rheumatoid arthritis and osteoarthritis.

How does it work?

NSAIDs work by blocking the action of a substance in the body called cyclo-oxygenase. Cyclo-oxygenase is involved in producing prostaglandins, in response to injury or certain diseases. These prostaglandins cause pain, swelling and inflammation. Because NSAIDs block the production of these prostaglandins, they are effective at relieving pain and inflammation.

Cyclo-oxygenase does not only produce prostaglandins that cause inflammation. It also produces prostaglandins that have useful roles in the body. There are two different forms of cyclo-oxygenase, COX-1 and COX-2. COX-2 is the form that (among other things) produces prostaglandins that cause inflammation. COX-1 does not produce inflammatory prostaglandins, but does produce others that have useful effects, including some that are involved in maintaining a healthy stomach and intestinal lining.

Traditional NSAIDs, such as ibuprofen or diclofenac, block the action of both COX-1 and COX-2, and this is why they can sometimes cause side effects such as stomach irritation and peptic ulcers. Etodolac belongs to a new generation of NSAIDs that selectively block the action of COX-2. This means that it stops the production of inflammatory prostaglandins, without stopping the production of prostaglandins that protect the stomach and intestines. It therefore reduces pain and inflammation, but is less likely than traditional NSAIDs to cause side effects on the stomach and intestines (although such side effects are still possible).

Etodolac is used to relieve the pain of osteoarthritis and rheumatoid arthritis, which is caused by inflammation of the joints.

Who can get it?

This medicine is available on prescription for adults. Not recommended for children.

How is it used?

400-600 mg daily in two divided doses or as a single daily dose.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• Epigastric pain,
• GI upset or bleeding,
• headache,
• dizziness,
• tinnitus,
• rash,
• angioedema.

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Eccoxolac  is marketed in the UK by Meda Pharmaceuticals Ltd.

Review Date: September 2026
Version ID: 2/ECC/PAT/09/26

Felbinac is a type of medicine known as a non-steroidal anti-inflammatory drug (NSAID). It is applied to the skin to relieve local pain and inflammation associated with rheumatic and mild arthritic pain, sprains, strains and other soft-tissue injuries.

Felbinac has been available in gel and foam preparations. The gel formulation may also be used as a coupling agent during ultrasound treatment, where applicable.

How does it work?

Felbinac works by reducing the production of substances called prostaglandins. These substances are produced by the body in response to injury and inflammation and contribute to pain, swelling and inflammation.

When felbinac is applied to the skin, it is absorbed into the underlying tissues, where it acts locally to reduce pain and inflammation.

As with other topical NSAIDs, some medicine may enter the bloodstream. The amount absorbed is generally lower than with NSAIDs taken by mouth, although absorption may increase if large amounts are used, if the gel or foam is applied over large areas, or if it is used for prolonged periods.

Who can get it?

Felbinac topical preparations have been available on prescription for adults aged 18 years and over.

They should not be used by anyone who has had an allergic reaction to felbinac, aspirin or another NSAID. Speak to a doctor or pharmacist before use if you have asthma triggered by NSAIDs, a history of stomach ulcers, kidney problems, or if you are pregnant or breastfeeding.

How is it used?

Apply the preparation to the affected area and gently rub it into the skin.

The amount and frequency depend on the formulation:

• Gel: approximately 1g applied to the affected area two to four times daily.
• Foam: apply a golf-ball-sized amount to the affected area two to four times daily.

Do not exceed the recommended maximum daily amount stated on the product information.

• Do not apply to broken, infected or irritated skin.
• Avoid contact with the eyes, mouth, nose and other mucous membranes.
• Rinse with cold water if accidental contact occurs.
• Wash your hands after applying the medicine, unless the hands are being treated.
• Do not cover the treated area with airtight or waterproof dressings, including nappies, unless advised by a healthcare professional.
• Keep felbinac foam away from naked flames, as it is inflammable.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that may be associated with topical felbinac. Experiencing a side effect does not mean that everyone using the medicine will develop it.

• Redness or mild irritation at the application site
• Itching
• Skin inflammation or dermatitis
• Tingling, numbness or altered sensation
• Skin rash or increased sensitivity to sunlight
• Rarely, allergic reactions such as wheezing, facial swelling or difficulty breathing

Stop using the medicine and seek medical advice if you develop a significant skin reaction or symptoms of an allergic reaction.

Although absorption into the bloodstream is lower than with oral NSAIDs, excessive use or application over large areas may increase the risk of systemic NSAID-related side effects.

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Felbinac is marketed in the UK by Goldshield Pharmaceuticals Ltd and is known commercially as Traxam.

Review date: September 2026
Version ID: 2/FEB/PAT/09/26

Feldene contains the active ingredient piroxicam, which belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It is used to relieve pain and inflammation associated with osteoarthritis, rheumatoid arthritis and ankylosing spondylitis.

Piroxicam is not usually a first-choice NSAID because it has a higher risk of serious gastrointestinal side effects and certain skin reactions compared with some other NSAIDs. It should only be prescribed after an individual assessment of the potential benefits and risks.

Piroxicam relieves symptoms such as pain and stiffness but does not alter the underlying disease process and is not a disease-modifying antirheumatic drug (DMARD).

How does it work?

Piroxicam works by blocking the action of enzymes called cyclo-oxygenase (COX). These enzymes are involved in the production of substances called prostaglandins.

Prostaglandins are produced in response to injury, illness and inflammation and contribute to pain, swelling and inflammation. By reducing prostaglandin production, piroxicam helps relieve pain and inflammation.

Piroxicam has a long duration of action, so it is usually taken once a day. Feldene capsules should be swallowed with a drink, preferably with or after food. Feldene Melt tablets are designed to dissolve quickly in the mouth and can be swallowed with saliva or water.

Who can get it?

Feldene is available on prescription for adults. Treatment should be initiated by a doctor experienced in treating inflammatory or degenerative rheumatic conditions.

It may not be suitable for people with:

• A current or previous stomach or intestinal ulcer, bleeding or perforation
• Inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis
• Severe heart failure or significant heart or circulation problems
• Kidney or liver disease
• Asthma or allergic reactions triggered by aspirin or other NSAIDs
• A previous serious skin reaction to piroxicam or another medicine

Piroxicam should not be taken with another NSAID, including ibuprofen, naproxen, diclofenac or aspirin used for pain relief. It should also generally be avoided with anticoagulants such as warfarin unless specifically directed by a specialist.

Piroxicam should not be used during the last three months of pregnancy. It is not recommended while breastfeeding unless specifically advised by a doctor. It may also affect female fertility and is not recommended for women trying to conceive.

How is it used?

The usual adult dose is:

• 20mg once daily, usually as a single dose
• Some people may be maintained on 10mg once daily
• A dose of up to 30mg daily may occasionally be prescribed, but doses above 20mg carry an increased risk of gastrointestinal side effects and should only be used under specialist supervision

The lowest effective dose should be used for the shortest time necessary. Treatment should be reviewed within 14 days, and continued treatment should involve regular reassessment.

A proton pump inhibitor, such as omeprazole, may be prescribed to help reduce the risk of stomach or duodenal ulcers in people who require NSAID treatment and are at increased gastrointestinal risk.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that may be associated with piroxicam. Experiencing a side effect does not mean that everyone taking the medicine will develop it.

• Indigestion, stomach pain, nausea, vomiting, diarrhoea, constipation or wind
• Loss of appetite or inflammation of the mouth
• Headache, dizziness, drowsiness or tiredness
• Skin rash, itching or increased sensitivity to sunlight
• Fluid retention, swelling or increased blood pressure
• Changes in kidney or liver function
• Changes in blood counts

NSAIDs, including piroxicam, can cause serious gastrointestinal complications, including ulcers, bleeding or perforation. These may occur without warning and can occasionally be fatal.

Rarely, piroxicam can cause serious skin reactions, including blistering, peeling skin or sores affecting the mouth, eyes or other mucous membranes. Stop taking the medicine and seek urgent medical advice if these symptoms occur.

Seek urgent medical attention if you develop vomiting of blood, black or tar-like stools, severe abdominal pain, swelling of the face or throat, difficulty breathing, chest pain or sudden weakness.

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Feldene is marketed in the UK by Pfizer Ltd.

Review date: September 2026
Version ID: 2/FED/PAT/09/26

Fenbid Gel contains the active ingredient ibuprofen, which belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It is applied to the skin to relieve local pain and inflammation associated with backache, rheumatic and muscular pain, sprains, strains and some minor joint conditions.

Fenbid Gel and Fenbid Forte Gel may be used for painful muscular and joint conditions, including sprains, strains, backache, rheumatic pain and minor arthritic conditions.

How does it work?

Ibuprofen works by blocking the action of enzymes called cyclo-oxygenase (COX). These enzymes are involved in producing substances called prostaglandins.

Prostaglandins are produced in response to injury and inflammation and contribute to pain, swelling and inflammation. By reducing prostaglandin production, ibuprofen helps relieve pain and inflammation in the area where it is applied.

When ibuprofen is applied to the skin, it is absorbed into the underlying tissues, where it acts locally. Generally, less ibuprofen reaches the bloodstream than when ibuprofen is taken by mouth. However, some absorption into the bloodstream still occurs, particularly when large amounts are applied, when used over large areas or when used for prolonged periods.

Who can get it?

Fenbid Gel and Fenbid Forte Gel are available from pharmacies. They may be suitable for adults and children aged 14 years and over, depending on the specific product.

They should not be used by anyone who has had an allergic reaction to ibuprofen, aspirin or other NSAIDs. Speak to a pharmacist or doctor before use if you have asthma that is triggered by NSAIDs, a history of stomach ulcers, kidney problems, or if you are pregnant or breastfeeding.

How is it used?

Apply the gel to the affected area and gently massage it into the skin.

The usual directions are to apply the gel three or four times a day, following the instructions on the product packaging or leaflet.

• Wash your hands after applying the gel, unless the hands are the area being treated.
• Do not apply to broken, infected or irritated skin.
• Avoid contact with the eyes, mouth and other sensitive areas.
• Do not cover the treated area with an airtight or waterproof dressing.
• Do not use more frequently or for longer than recommended.

If symptoms worsen or do not improve after the recommended period, seek advice from a pharmacist or doctor.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that may be associated with topical ibuprofen. Experiencing a side effect does not mean that everyone using the medicine will develop it.

• Skin irritation, itching, redness or rash
• Burning or stinging at the application site
• Increased sensitivity to sunlight
• Allergic reactions, including wheezing or worsening asthma
• Rarely, more serious allergic reactions such as swelling of the lips, face, throat or tongue, or difficulty breathing

Stop using the gel and seek medical advice if you develop a significant skin reaction or symptoms of an allergic reaction.

Although absorption into the bloodstream is lower than with oral ibuprofen, using excessive amounts or applying the gel over large areas may increase the risk of NSAID-related side effects, including stomach, kidney or other systemic effects.

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Fenbid Gel is marketed in the UK by Goldshield Pharmaceuticals Ltd

Review date: September 2026
Version ID: 2/FEN/PAT/09/26

Fenbid Spansules contain the active ingredient ibuprofen, which is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID). Ibuprofen helps relieve pain and reduce inflammation. It may be prescribed for conditions such as rheumatoid arthritis, juvenile idiopathic arthritis, ankylosing spondylitis, osteoarthritis and other painful musculoskeletal conditions.

Ibuprofen can relieve symptoms, but it does not alter the underlying disease process and is not a disease-modifying antirheumatic drug (DMARD).

How does it work?

Ibuprofen works by blocking the action of enzymes called cyclo-oxygenase (COX). These enzymes are involved in the production of substances called prostaglandins.

Prostaglandins are produced in response to injury, illness and inflammation. They contribute to pain, swelling and inflammation. By reducing prostaglandin production, ibuprofen helps relieve pain, stiffness and inflammation.

Fenbid Spansules are modified-release capsules. They release ibuprofen gradually over several hours to provide longer-lasting relief. The capsules should be swallowed whole and must not be chewed, crushed or opened, as this may affect the modified-release action.

Who can get it?

Fenbid Spansules are available on prescription for adults. They may not be suitable for everyone, particularly people with a history of stomach ulcers or gastrointestinal bleeding, heart or circulation problems, high blood pressure, kidney or liver disease, asthma triggered by aspirin or other NSAIDs, or an allergy to NSAIDs.

They should not normally be used during the last three months of pregnancy. Speak to your doctor or pharmacist if you are pregnant, planning a pregnancy or breastfeeding.

How is it used?

The dose is prescribed according to the condition being treated and the individual’s response.

The usual adult dose is:

• Initially, two 300mg capsules daily, usually taken as one capsule twice daily.
• If necessary, the dose may be increased to three 300mg capsules daily, taken in divided doses.

Take Fenbid Spansules with or after food if they cause stomach discomfort. Use the lowest effective dose for the shortest time necessary.

Do not take Fenbid with another NSAID, such as ibuprofen, naproxen, diclofenac or aspirin for pain, unless specifically advised by your doctor.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that may be associated with ibuprofen. Experiencing a side effect does not mean that everyone taking the medicine will develop it.

• Indigestion, stomach pain, nausea or diarrhoea
• Stomach or intestinal ulcers, bleeding or, rarely, perforation
• Headache, dizziness or drowsiness
• Skin rash, itching or other allergic reactions
• Fluid retention, swelling or increased blood pressure
• Changes in kidney or liver function
• Changes in blood counts, including a reduction in platelets

Stop taking the medicine and seek urgent medical advice if you develop signs of gastrointestinal bleeding, such as vomiting blood or passing black, tar-like stools, or symptoms of a serious allergic reaction, such as swelling of the face or throat or difficulty breathing.

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Fenbid Spansules are marketed in the UK by Mercury Pharma Group Ltd. They contain ibuprofen 300mg in a modified-release capsule formulation.

Review date: September 2026
Version ID: 2/FEN/PAT/09/26

Fenoprofen is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID). NSAIDs are used to relieve pain, swelling and inflammation. Fenoprofen has been used to treat pain and inflammation associated with conditions such as rheumatoid arthritis and osteoarthritis.

How does it work?

Fenoprofen works by reducing the production of substances called prostaglandins. Prostaglandins are involved in causing pain, swelling and inflammation in response to injury or disease.

By reducing the production of these substances, fenoprofen can help relieve pain and inflammation. Like other NSAIDs, it treats symptoms but does not alter the underlying course of conditions such as rheumatoid arthritis.

Who can get it?

Fenoprofen has been available on prescription for adults. It is not generally recommended for children.

How is it used?

It should be taken with or after food to help reduce stomach irritation.

The lowest effective dose should be used for the shortest possible time.

Fenoprofen should not be taken at the same time as another NSAID, such as ibuprofen, naproxen or diclofenac, unless specifically advised by a healthcare professional.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that have been associated with fenoprofen. Having a side effect listed here does not mean that everyone taking the medicine will experience it.

• Indigestion, stomach pain or other gastrointestinal problems
• Nausea or vomiting
• Headache or dizziness
• Skin rash or itching
• Allergic reactions
• Kidney or liver problems
• Changes in blood cell counts
• Stomach ulcer or bleeding

Like other NSAIDs, fenoprofen can rarely cause serious gastrointestinal, kidney, liver, allergic or cardiovascular problems. Seek medical attention if you develop signs of an allergic reaction, severe stomach pain, vomiting blood, black stools, difficulty breathing or swelling of the face or throat.

Fenoprofen can interact with a number of medicines, including blood-thinning medicines, some medicines for high blood pressure, diuretics (water tablets), lithium, methotrexate, ciclosporin and corticosteroids. Tell your doctor or pharmacist about all the medicines you are taking before starting fenoprofen.

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Fenoprofen is marketed in the UK by Typharm Ltd and is known commercially as Fenopron

Review date: September 2026
Version ID: 2/ FEP/PAT/09/26

Flurbiprofen is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID). NSAIDs are used to relieve pain, swelling and inflammation. Flurbiprofen is used to treat conditions such as rheumatoid arthritis, osteoarthritis, ankylosing spondylitis and other musculoskeletal conditions.

How does it work?

Flurbiprofen works by reducing the production of substances called prostaglandins. Prostaglandins are involved in causing pain, swelling and inflammation in response to injury or disease.

By reducing the production of prostaglandins, flurbiprofen can help relieve pain and inflammation. Like other NSAIDs, it treats symptoms but does not alter the underlying course of conditions such as rheumatoid arthritis.

Who can get it?

Flurbiprofen is available on prescription for adults. It is not recommended for children under 12 years.

People who have had stomach ulcers or bleeding, heart, kidney or liver problems, asthma triggered by NSAIDs, or an allergic reaction to aspirin or other NSAIDs may not be able to take flurbiprofen. Your doctor will also consider other medicines you are taking and whether you are pregnant.

How is it used?

The usual adult dose is 150–200 mg daily, taken in two, three or four divided doses. In some people with severe symptoms or during an acute flare, the dose may be increased to 300 mg daily in divided doses.

Flurbiprofen should preferably be taken with or after food.

The lowest effective dose should be used for the shortest possible time.

Flurbiprofen should not be taken with another NSAID, such as ibuprofen, naproxen or diclofenac, unless specifically advised by a healthcare professional.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that can occur with this medicine. Having a side effect listed here does not mean that everyone taking flurbiprofen will experience it.

• Indigestion, stomach pain or other gastrointestinal problems
• Nausea or vomiting
• Headache or dizziness
• Skin rash or itching
• Fluid retention or swelling
• Changes in blood pressure
• Changes in liver or kidney function
• Changes in blood cell counts

Like other NSAIDs, flurbiprofen can sometimes cause stomach ulcers or bleeding. Rarely, serious allergic reactions, liver or kidney problems and cardiovascular problems can occur.

Seek medical attention if you develop severe stomach pain, vomiting blood, black stools, difficulty breathing, swelling of the face or throat, or other symptoms of a serious allergic reaction.

Flurbiprofen can interact with a number of medicines, including blood-thinning medicines, some medicines for high blood pressure, diuretics (water tablets), lithium, methotrexate, ciclosporin and corticosteroids. Tell your doctor or pharmacist about all the medicines you are taking before starting flurbiprofen.

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Flurbiprofen 50 mg and 100 mg tablets are marketed in the UK by Viatris.

Review Date: September 2026
Version ID: 2/FLU/PAT/09/26

Ibugel contains the active ingredient ibuprofen, which belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It is used to relieve pain and inflammation associated with backache, rheumatic and muscular pain, sprains, strains, neuralgia and some minor arthritic conditions.

Ibugel is available as a 5% gel and Ibugel Forte as a 10% gel.

How does it work?

Ibuprofen works by reducing the production of substances called prostaglandins. Prostaglandins are produced in response to injury or disease and are involved in causing pain, swelling and inflammation.

When ibuprofen is applied to the skin, it passes through the skin into the underlying tissues where it helps reduce pain and inflammation in the affected area. The aqueous-alcoholic gel can also have a cooling and soothing effect when applied.

Less ibuprofen reaches the bloodstream from a topical preparation than from ibuprofen taken by mouth. However, some absorption into the bloodstream can occur, particularly when large amounts are used or large areas of skin are treated.

Who can get it?

Ibugel 5% and Ibugel Forte 10% are available in the UK. The appropriate product and supply status depends on the strength and pack.

They are generally not recommended for children under 12 years unless advised by a doctor.

Ibugel should not be used by people who have previously had an allergic reaction to ibuprofen, aspirin or other NSAIDs, particularly where these medicines have caused asthma, rhinitis or urticaria.

How is it used?

Apply the gel to the affected area and massage gently into the skin until absorbed.

For Ibugel 5%, apply to the affected area up to three times a day, or as directed by a doctor.

For Ibugel Forte 10%, apply 2–5 cm of gel to the affected area up to three times a day, or as directed by a doctor. Wash your hands after application unless the hands are being treated.

Do not apply the gel to broken or damaged skin. Avoid contact with the eyes and mucous membranes.

Treatment should normally be limited to a few weeks unless your doctor advises you to continue for longer.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. Having a side effect listed here does not mean that everyone using the medicine will experience it.

Topical ibuprofen is generally well tolerated, but possible side effects include:

• Skin irritation, redness, itching or rash
• Burning or stinging at the site of application
• Increased sensitivity to sunlight
• Allergic reactions

Rarely, ibuprofen absorbed through the skin can cause effects similar to those associated with oral NSAIDs, including breathing difficulties or other allergic reactions.

Stop using the gel and seek medical advice if you develop a significant skin reaction, difficulty breathing, swelling of the face or throat, or other signs of a serious allergic reaction.

Ibugel should not be used at the same time as other NSAIDs without advice from a doctor or pharmacist.

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Ibugel and Ibugel Forte are marketed in the UK by Dermal Laboratories Ltd.

Review date: September 2026
Version ID: 2/IBU/PAT/09/26

This page is for reference only as this product is now discontinued

Ibumousse contains the active ingredient ibuprofen, which belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It was used as a topical treatment for pain and inflammation caused by backache, rheumatic and muscular pain, sprains, strains, neuralgia and common arthritic conditions.

Ibumousse contains ibuprofen 5% and was supplied as a mousse (foam) for application to the skin.

Please note: Ibumousse is no longer listed as a current UK product on the electronic Medicines Compendium (eMC), and appears to no longer be generally available. Current topical ibuprofen products are available in other formulations.

How does it work?

Ibuprofen works by blocking the action of cyclo-oxygenase (COX), an enzyme involved in producing substances called prostaglandins.

Prostaglandins are produced in response to injury and certain diseases and can cause pain, swelling and inflammation. By reducing the production of prostaglandins, ibuprofen helps to relieve pain and inflammation.

When ibuprofen is applied to the skin, it is absorbed into the tissues around the affected area, where it can help reduce local pain and inflammation. Less ibuprofen generally reaches the bloodstream than when ibuprofen is taken by mouth, although some absorption can still occur.

Who can get it?

Ibumousse was intended for adults, older people and children over 12 years of age. Children under 12 years were only to use it if advised by a doctor.

It should not be used by people who have previously had an allergic reaction to ibuprofen, aspirin or other NSAIDs, including some people with asthma, allergic rhinitis or urticaria triggered by these medicines.

It should not be applied to broken, damaged, infected or diseased skin.

How is it used?

Ibumousse was for application to the affected area of skin.

The usual instructions were to dispense approximately 1–2g of mousse into the palm of the hand and gently massage it into the affected area until absorbed. It could be applied three to four times a day, or as directed by a doctor.

It should not be applied near the eyes, nose or mouth. The mousse was flammable and should be kept away from flames and other sources of ignition.

Because some ibuprofen can be absorbed into the bloodstream, people taking aspirin or other NSAIDs should speak to their doctor or pharmacist before using a topical ibuprofen product.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that can occur with topical ibuprofen. Because a side effect is listed here, it does not mean that everyone using the medicine will experience it.

• Skin irritation, redness, itching or rash
• Burning or stinging at the application site
• Allergic reactions, including worsening asthma or narrowing of the airways (bronchospasm)
• Swelling of the face, lips, tongue or throat (angioedema)
• Severe allergic reactions, including anaphylaxis

Although topical ibuprofen is absorbed less into the bloodstream than ibuprofen taken by mouth, systemic side effects are possible, particularly if large amounts are used over large areas of skin.

Stop using the product and seek medical advice if you develop a significant skin reaction, breathing difficulties or swelling of the face, lips, tongue or throat.

Marketed by

Ibumousse was marked by Dermal Laboratories/Diomed Developments in the UK.

Reviewed: September 2026
Version ID: 2/IBU/PAT/09/26

Ibuspray contains the active ingredient ibuprofen, which belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It is used to treat pain caused by backache, rheumatic and muscular pain, sprains, strains and neuralgia. It can also be used to relieve pain associated with non-serious arthritic conditions.

Ibuspray contains ibuprofen 5% and is applied directly to the skin over the painful area.

How does it work?

Ibuprofen works by blocking the action of an enzyme called cyclo-oxygenase (COX). COX is involved in the production of substances called prostaglandins.

Prostaglandins are produced in response to injury and certain diseases and can cause pain, swelling and inflammation. By reducing the production of prostaglandins, ibuprofen helps to relieve pain and inflammation.

When Ibuspray is applied to the skin, ibuprofen passes through the skin into the tissues underneath, where it acts directly on the painful area. The spray also has a soothing and cooling effect.

Less ibuprofen reaches the bloodstream from a topical preparation than from ibuprofen taken by mouth, although some absorption does occur.

Who can get it?

Ibuspray is available from pharmacies and on NHS prescription.

It can be used by adults, older people and children over 12 years of age. Children under 12 should only use Ibuspray if advised by a doctor.

Ibuspray should not be used by anyone who has previously had an allergic reaction to ibuprofen, aspirin or other NSAIDs. Particular caution is needed in people who have asthma, rhinitis or urticaria associated with these medicines.

It should not be used on broken, damaged, infected or diseased skin.

Ibuspray should not be used during pregnancy or breastfeeding.

How is it used?

Hold the bottle approximately 10–15 cm (4–6 inches) from the skin and spray over the affected area.

After every 2–3 sprays, gently massage the preparation into the skin and spread it over the area around the painful site.

Normally, 5–10 sprays (approximately 1–2 ml) are sufficient. This can be repeated three to four times a day, or as directed by a doctor. Do not use excessively.

Wash your hands after applying the spray, unless the hands are the area being treated.

Treatment should not normally continue for more than a few weeks unless advised by a doctor.

Ibuspray is flammable. Do not spray it near naked flames, cigarettes, electric heaters or other sources of ignition. Clothing, bedding and dressings that have come into contact with the product can also present a fire risk.

If you are taking aspirin or another NSAID by mouth, speak to your doctor or pharmacist before using Ibuspray, as this may increase the risk of side effects.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that can occur with Ibuspray. Because a side effect is listed here, it does not mean that everyone using the medicine will experience it.

• Skin rash, itching or irritation
• Redness or other skin reactions at the application site
• Increased sensitivity of the skin to sunlight
• Allergic reactions, including worsening asthma or narrowing of the airways (bronchospasm)
• Swelling of the lips, face, tongue or throat (angioedema)
• Rarely, more serious allergic reactions

Serious skin reactions have very rarely been reported with ibuprofen. Stop using Ibuspray and seek medical attention if you develop a severe skin rash, blistering, peeling skin or sores affecting the mouth, eyes or other mucous membranes.

Although topical ibuprofen is absorbed less into the bloodstream than ibuprofen taken by mouth, systemic side effects are possible, particularly if large amounts are used.

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Ibuspray is marketed in the UK by Dermal Laboratories Ltd.

Review date: September 2026
Version ID: 2/IBS/PAT/09/26

Lodine SR contains the active ingredient etodolac, which belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It is used to relieve pain, stiffness and inflammation associated with rheumatoid arthritis and osteoarthritis.

Lodine SR is a prolonged-release tablet containing 600mg of etodolac. It is a prescription-only medicine for adults.

How does it work?

Etodolac works by reducing the production of substances called prostaglandins. Prostaglandins are produced in response to injury and certain diseases and can contribute to pain, swelling and inflammation.

Etodolac inhibits cyclo-oxygenase (COX), an enzyme involved in the production of prostaglandins. It has some preference for COX-2, which is associated with inflammation, although the clinical benefit of this preferential COX-2 activity compared with other NSAIDs has not been proven.

Like other NSAIDs, etodolac can cause side effects affecting the stomach, kidneys, heart and circulation. It is used to relieve symptoms but does not treat the underlying cause of rheumatoid or osteoarthritis.

Who can get it?

Lodine SR is available on prescription for adults. It is not recommended for children.

It may not be suitable for people who have had stomach or intestinal ulcers or bleeding, severe heart, liver or kidney problems, or an allergic reaction or asthma triggered by aspirin or other NSAIDs.

People who are taking medicines that increase the risk of stomach bleeding, such as anticoagulants, antiplatelet medicines, corticosteroids or some antidepressants, should tell their doctor before taking Lodine SR.

Lodine should not be used during the third trimester of pregnancy. NSAIDs should generally be avoided during pregnancy unless specifically advised by a healthcare professional.

How is it used?

The usual adult dose is one 600mg tablet once a day.

The tablet should preferably be taken with or after food and swallowed whole with a glass of water. It should not be crushed or chewed.

If a lower dose is needed, a conventional etodolac preparation may be prescribed instead.

The lowest effective dose should be used for the shortest time necessary to control symptoms. The safety of doses above 600mg a day has not been established.

Lodine SR should not be taken at the same time as another NSAID, including aspirin used as a painkiller, unless advised by a healthcare professional.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that can occur with Lodine SR. Because a side effect is listed here, it does not mean that everyone taking the medicine will experience it.

• Indigestion, stomach pain, nausea or diarrhoea
• Headache or dizziness
• Drowsiness or tiredness
• Ringing in the ears (tinnitus)
• Skin rash or itching
• Fluid retention and swelling (oedema)
• Raised blood pressure
• Changes in kidney or liver function

NSAIDs such as etodolac can sometimes cause stomach or intestinal ulcers or bleeding, which can occasionally be serious or life-threatening. The risk is higher with increasing age, higher doses and longer treatment.

Serious allergic reactions can occur, including breathing difficulties, worsening asthma and swelling of the face, lips, tongue or throat.

Very rarely, serious skin reactions can occur. Stop taking Lodine SR and seek medical advice if you develop a severe skin rash, blistering, peeling skin or sores affecting the mouth, eyes or other mucous membranes.

Long-term or high-dose NSAID treatment may also be associated with a small increased risk of heart attack or stroke.

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Lodine SR is marketed in the UK by Almirall Ltd

Review date: September 2026
Version ID: 2/LOD/PAT/09/26

Mefenamic acid is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID). It is used to relieve pain and inflammation in conditions including rheumatoid arthritis and osteoarthritis. It can also be used for muscular and traumatic pain, such as pain following sprains, fractures and other injuries.

Mefenamic acid is available as capsules and tablets and is also available as an oral suspension.

How does it work?

Mefenamic acid works by reducing the production and effects of substances called prostaglandins.

Prostaglandins are produced by the body in response to injury and certain diseases and can cause pain, swelling and inflammation. Mefenamic acid blocks the action of cyclo-oxygenase (COX), an enzyme involved in producing prostaglandins. This helps to reduce pain and inflammation.

Mefenamic acid may also reduce the effects of prostaglandins after they have already been produced.

It provides relief from the symptoms of conditions such as rheumatoid arthritis and osteoarthritis but does not treat the underlying cause of these conditions.

Who can get it?

Mefenamic acid is available on prescription.

It can be used by adults and older people. Different formulations are available for children, including an oral suspension for children under 12 years.

Mefenamic acid may not be suitable for people who have, or have previously had, stomach or intestinal ulcers or bleeding, inflammatory bowel disease, severe heart, liver or kidney problems, or an allergic reaction to aspirin or other NSAIDs.

It should not be taken during the last three months of pregnancy and should not be taken while breastfeeding unless specifically advised by a healthcare professional.

How is it used?

The usual adult dose is 500 mg three times daily.

Mefenamic acid should preferably be taken with or after food.

The lowest effective dose should be used for the shortest time necessary to control symptoms.

Mefenamic acid should not be taken at the same time as another NSAID, including ibuprofen, naproxen or diclofenac, unless advised by a healthcare professional.

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that can occur with mefenamic acid. Because a side effect is listed here, it does not mean that everyone taking the medicine will experience it.

• Indigestion, stomach pain, nausea or vomiting
• Diarrhoea
• Headache or dizziness
• Drowsiness or tiredness
• Ringing in the ears (tinnitus)
• Skin rash or itching
• Changes in liver or kidney function
• Changes in blood counts

Diarrhoea is an important side effect of mefenamic acid. It can occur soon after starting treatment or after several months of treatment. If diarrhoea develops, stop taking mefenamic acid and contact your doctor.

Like other NSAIDs, mefenamic acid can sometimes cause stomach or intestinal ulcers or bleeding, which can occasionally be serious or life-threatening.

Serious allergic reactions can occur, including breathing difficulties, worsening asthma and swelling of the face, lips, tongue or throat.

Very rarely, serious skin reactions can occur. Stop taking the medicine and seek medical advice if you develop a severe skin rash, blistering, peeling skin or sores affecting the mouth, eyes or other mucous membranes.

Long-term or high-dose treatment with NSAIDs may also be associated with an increased risk of heart attack or stroke.

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Mefenamic acid is available in the UK from several manufacturers. Ponstan Capsules 250mg and Ponstan Forte Tablets 500mg are marketed by Chemidex Pharma Ltd. Generic mefenamic acid products are also available.

Review Date: September 2026
Version ID: 2/MEF/PAT/09/26

Motifene contains the active ingredient diclofenac sodium, a non-steroidal anti-inflammatory drug (NSAID) used to relieve pain and inflammation.

It can be used for conditions including:

• rheumatoid arthritis and osteoarthritis
• ankylosing spondylitis
• acute attacks of gout
• acute musculoskeletal conditions, such as frozen shoulder, tendon inflammation, bursitis, sprains and strains
• pain following fractures or other injuries
• lower back pain
• pain and inflammation following orthopaedic, dental or other minor surgery.

How does it work?

Diclofenac works by reducing the production of substances called prostaglandins. Prostaglandins are involved in causing pain, swelling and inflammation. By reducing their production, diclofenac helps relieve pain and inflammation.

Motifene 75 mg capsules contain 75 mg of diclofenac sodium. The capsule contains two types of pellets: some release diclofenac relatively quickly, while the remainder release it more slowly. This provides both an initial and a longer-lasting effect.

The capsules are modified release and should be swallowed whole with plenty of liquid. Do not chew or open the capsules.

Who can get it?

Motifene is available on prescription for adults. Its safety and effectiveness have not been established in children and adolescents under 18 years.

Diclofenac may not be suitable for people with certain stomach, heart, kidney or liver problems, or for those who have previously had an allergic reaction to aspirin or other NSAIDs. Tell your doctor or pharmacist about any other medicines you take.

How is it used?

The usual adult dose is one 75 mg capsule once a day.

If necessary, the dose may be increased to one capsule twice a day, with the second dose taken 8–12 hours after the first. The maximum recommended daily dose of diclofenac is 150 mg.

Motifene should preferably be taken with or after food. Use the lowest effective dose for the shortest time needed to control your symptoms.

Do not take Motifene with other NSAIDs, such as ibuprofen, naproxen or aspirin for pain relief, unless advised to do so by a healthcare professional.

What are the side effects?

The most common side effects are related to the digestive system and may include:

• stomach pain or indigestion
• nausea or vomiting
• diarrhoea or constipation
• wind

Diclofenac can cause stomach or duodenal ulcers and bleeding. Seek urgent medical attention if you pass black, tarry stools, vomit blood or material that looks like coffee grounds, or develop severe stomach pain.

Other possible side effects include:

• headache, dizziness or drowsiness
• skin rash or itching
• swelling of the feet or ankles
• changes in blood pressure
• changes in liver or kidney function
• changes in blood test results
• ringing in the ears or changes in vision.

Serious allergic reactions can occur and may cause wheezing, difficulty breathing or swelling of the face, lips, mouth or throat.

Diclofenac can also slightly increase the risk of heart attack or stroke, particularly with higher doses and longer-term treatment. It should therefore be used at the lowest effective dose for the shortest possible time.

If you develop a severe skin rash, blistering or sores in the mouth or eyes, stop taking Motifene and seek medical advice immediately.

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Motifene is marketed in the UK by Daiichi Sankyo UK Ltd.

Review date: September 2026
Version ID: 2/MOT/PAT/09/26

Nabumetone is a non-steroidal anti-inflammatory drug (NSAID) used to reduce pain, stiffness and swelling associated with osteoarthritis and rheumatoid arthritis.

Nabumetone is a non-acidic NSAID. It is converted in the body to an active substance that reduces the production of prostaglandins, chemicals involved in pain and inflammation. Nabumetone helps control symptoms but does not alter the underlying cause of rheumatoid arthritis.

How does it work?

Nabumetone reduces the production of prostaglandins, which are involved in causing pain, swelling and inflammation.

By reducing inflammation, nabumetone can help relieve pain and stiffness and improve movement in people with osteoarthritis or rheumatoid arthritis.

Nabumetone may begin to relieve pain after the first few doses, although its full anti-inflammatory effect can take longer to develop.

Who can take nabumetone?

Nabumetone is available on prescription for adults. It is not recommended for children.

Your doctor may advise against nabumetone if you have, or have previously had, a stomach ulcer or gastrointestinal bleeding, severe heart, liver or kidney problems, or an allergic reaction to aspirin or other NSAIDs.

Nabumetone can increase the risk of stomach bleeding, kidney problems and cardiovascular problems, particularly with higher doses or long-term treatment. Your doctor will consider your individual risks and may prescribe a stomach-protecting medicine if appropriate.

How is it used?

The usual adult dose is 1 g once a day, taken at bedtime. This is two 500 mg tablets.

If symptoms are severe or persistent, your doctor may prescribe an additional 500 mg to 1 g as a morning dose. The maximum dose is generally 2 g a day.

People aged 65 and over are usually started on 500 mg once a day, and should not normally take more than 1 g a day.

Nabumetone should preferably be taken with or after food and the tablets should be swallowed whole with water.

As with other NSAIDs, the lowest effective dose should be used for the shortest time needed to control symptoms. Nabumetone should not be taken together with other NSAIDs unless specifically advised by your doctor.

What are the side effects?

The most common side effects include:

• Diarrhoea
• Constipation
• Indigestion
• Nausea
• Abdominal pain
• Flatulence
• Rash
• Swelling caused by fluid retention

Less commonly, nabumetone can cause stomach ulcers or bleeding, changes in kidney or liver function, raised blood pressure, dizziness or tiredness.

Seek urgent medical attention if you develop signs of a serious allergic reaction, vomit blood, pass black stools, or develop a severe skin reaction such as a widespread rash, blistering or peeling skin.

Long-term or high-dose treatment with NSAIDs can increase the risk of heart attack or stroke. Your doctor will take this into account when deciding whether nabumetone is suitable for you.

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Nabumetone 500 mg film-coated Tablets are currently marketed in the UK by Tillomed Laboratories Ltd.

Reviewed: September 2026
Version ID: 2/NAB/PAT/09/26

This page is for reference only as this product is now discontinued

Napratec contains the active ingredients naproxen which belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs) in one tablet plus a Cytotec tablet containing Misoprostol, a synthetic prostaglandin used to prevent gastric effects of the naproxen. Napratec is used for the treatment of acute osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.

How does it work?

It works by blocking the production of a group of chemical (prostaglandins) which the body produces in response to injury or certain diseases. These prostaglandins would otherwise go on to cause swelling, pain and inflammation.

Since prostaglandins also have a role in protecting the stomach lining, a reduction in prostaglandin levels sometimes causes gastric irritation or ulceration.

Misoprostol is a synthetic prostaglandin E1 analogue. It protects the lining of the stomach by mimicking the action of the naturally-occurring prostaglandins. Prostaglandins influence several factors involved in protection of the stomach lining. Misoprostol is used to promote peptic ulcer healing and relief of symptoms.

Misoprostol is added to the naproxen in this medicine to prevent the formation of ulcers caused by the effects of the naproxen.

Who can get it?

Available on prescription for adults.

How is it used?

You should normally take one Cytotec tablet and one naproxen tablet at the same time, twice a day with food.
Each wallet contains one week's supply of tablets. The wallet is divided into morning and evening doses and marked with the days of the week to help you remember how to take them.

What are the side effects?

All medicines can sometimes cause problems. You may get some of the following effects.

• The most common side effects are feeling or being sick, stomach pain, indigestion. Sometimes this can be a sign of an ulcer. This is unlikely to happen with Napratec. Occasionally you can get an inflammation of the bowel (symptoms may include cramp, bloating and possible diarrhoea). See your doctor if you get any of these problems for the first time.
• The Cytotec in Napratec can also cause stomach upsets and wind. Diarrhoea is the most common problem and is usually mild. You have less chance of getting diarrhoea if you take Napratec with food. If you use an antacid (something to reduce acid in the stomach) you should avoid antacids with magnesium in them as these may make diarrhoea worse. Your pharmacist can help you choose a suitable antacid. If this diarrhoea continues and causes you trouble, tell your doctor.
• Some people get skin rashes or other effects on the skin such as an increased sensitivity to sunlight, tingling and prickling feeling or bruising. If you get a rash or other skin reaction contact your doctor. Some people may get respiratory tract reactions such as asthma, bronchospasm or difficulty breathing. There have also been cases of hair loss or thinning in people taking naproxen.
• Some people also occasionally get disorders of the blood. You can become anaemic, or have problems with some types of blood cells called 'platelets' or 'granulocytes'. These problems can be picked up with blood tests.
• The Cytotec tablets occasionally can cause women to have problems with their periods. This can mean they may have heavy bleeding or bleeding between periods. Some women may have vaginal bleeding even though they have gone through the menopause.
• Some people get headaches, fatigue, drowsiness, confusion, depression, hallucinations, have trouble sleeping or concentrating or performing mental tasks.
• Some people get kidney or liver problems (these show up in their blood tests) although these are rarely serious, they can be fatal.
• Some people get dizzy or have balance problems. They may have ringing in the ears or other hearing problems. You may get swelling of the feet, ankles or hands. Very occasionally you may have problems with your sight (for example blurred vision), or with your kidneys, including passing urine with blood in it.
• Some people may develop an allergic reaction in their lungs and develop wheezing or breathlessness.
• You could also get inflammation of your blood vessels resulting in swelling of the face and/or throat, a sore mouth, mouth ulcers or meningitis (symptoms which may include neck stiffness, dislike of bright lights and a rash). These problems are rare.

Marketed by

Napratec is marketed in the UK by Pfizer Ltd.

Reviewed: September 2026
Version ID: 2/NAT/PAT/09/26

Naprosyn contains the active ingredient naproxen, which belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs) used for the treatment of acute osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.

How does it work?

Naproxen works by blocking the action of a substance in the body called cyclo-oxygenase (COX). Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced by the body in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. Naproxen blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.

Naproxen is used to relieve pain and inflammation in a wide range of musculoskeletal conditions, including various forms of arthritis, gout, muscle sprains and strains, back pain, neck pain and tendinitis. It can also be used to relieve period pain.

Naprosyn EC tablets have a special 'enteric coat' that is designed to prevent the tablet breaking down and releasing the naproxen in the stomach, and thus reduce the risk of it irritating the stomach. When the tablet reaches the intestine, the coating dissolves and the naproxen is absorbed into the bloodstream. The tablets should be swallowed whole and not broken or chewed to avoid damaging this coating.

Who can get it?

Available on prescription for adults and children over the age of 16 years.

How is it used?

For rheumatoid arthritis, osteoarthritis or ankylosing spondylitis

Take between 500mg and 1g each day in two separate doses, 12 hours apart. Where 1g per day is needed, you can take 500mg twice each day, or 1g in one single dose (morning or evening).

In some people, a larger dose of between 750mg and 1g per day may be taken to start with to control the pain. This is in patients with:

- severe night-time pain and/or morning stiffness.
- if your tablets have recently been changed from a high dose of another treatment for pain.
- osteoarthritis where pain is your main problem.

What are the side effects?

All medicines can sometimes cause problems. You may get some of the following effects.

• Rash,
• GI intolerance,
• headache,
• tinnitus,
• vertigo,
• blood dyscrasias,
• renal impairment,
• cardiovascular disorders

Read reviews or write your own

If you would like to read other people’s experience of this treatment, or have any comments to share, good or bad, you might like to go to iWantGreatCare

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Naproxen is known commercially as Naprosyn is marketed in the UK by Roche Products Ltd

This page is for reference only as this product is now discontinued

Orudis contains the active ingredient ketoprofen, a non-steroidal anti-inflammatory drug (NSAID). Ketoprofen was used to reduce pain and inflammation associated with conditions such as rheumatoid arthritis, osteoarthritis and ankylosing spondylitis.

How does it work?

Ketoprofen reduces the production of prostaglandins, chemicals involved in pain, swelling and inflammation.

By reducing prostaglandin production, ketoprofen can help relieve pain, stiffness and inflammation associated with arthritis and other musculoskeletal conditions.

Ketoprofen treats the symptoms of these conditions but does not alter the underlying disease.

Who can get it?

Orudis was available on prescription for adults.

NSAIDs such as ketoprofen are not suitable for everyone. They may not be appropriate if you have, or have previously had, a stomach ulcer or gastrointestinal bleeding, certain heart, kidney or liver problems, or an allergic reaction to aspirin or other NSAIDs.

How was it used?

The original Orudis capsules were available in different strengths. The dose depended on the formulation and the condition being treated.

The historical recommended adult dose was generally 50–100 mg twice daily, with the capsules taken with or after food to reduce the risk of stomach irritation.

The lowest effective dose was recommended for the shortest possible time.

Orudis should not have been taken together with other NSAIDs unless specifically advised by a doctor.

What are the side effects?

Like other NSAIDs, ketoprofen can cause side effects. These may include:

• Indigestion, stomach pain, nausea or diarrhoea
• Headache or dizziness
• Tiredness or drowsiness
• Skin rash or itching
• Fluid retention and swelling
• Changes in kidney or liver function
• Changes in blood cell counts

More serious side effects can include stomach ulcers or gastrointestinal bleeding, kidney problems, liver problems, severe allergic reactions and cardiovascular problems.

Rarely, serious skin reactions can occur. Stop taking the medicine and seek medical advice if you develop a severe or rapidly spreading rash, blistering or peeling skin.

Seek urgent medical attention if you vomit blood, pass black stools, develop severe breathing difficulties or swelling of the face or throat.

Marketed by

Orudis was marketed in the UK by Sanofi-Aventis.

Reviewed: September 2026
Version ID: 2/ORU/PAT/09/26

Oruvail prolonged-release capsules contain the active ingredient ketoprofen, a non-steroidal anti-inflammatory drug (NSAID). They are used to relieve pain, stiffness and inflammation associated with conditions such as rheumatoid arthritis, osteoarthritis and ankylosing spondylitis.

Oruvail capsules are prolonged-release capsules, which release ketoprofen gradually over several hours. They are available in 100 mg and 200 mg strengths.

How does it work?

Ketoprofen reduces the production of prostaglandins, chemicals involved in pain, swelling and inflammation.

By reducing prostaglandin production, ketoprofen can help relieve pain, stiffness and inflammation affecting the joints, muscles and other tissues.

Oruvail can be used for a range of painful inflammatory conditions, including rheumatoid arthritis, osteoarthritis, problems affecting the spine such as ankylosing spondylitis, lower back pain, sprains and strains.

Oruvail treats symptoms but does not alter the underlying cause of rheumatoid arthritis or other inflammatory conditions.

Because Oruvail is a prolonged-release preparation, it releases ketoprofen slowly and is normally taken once daily.

Who can get it?

Oruvail is available on prescription for adults.

It may not be suitable if you have, or have previously had, a stomach ulcer or gastrointestinal bleeding, severe heart, liver or kidney problems, or an allergic reaction to aspirin or other NSAIDs.

Particular care is needed in people aged 65 and over and in people with heart or circulation problems, asthma, Crohn's disease or ulcerative colitis.

How is it used?

The usual dose is 100 mg or 200 mg once a day, depending on your condition and your response to treatment.

The capsules should be swallowed whole with water and should not be opened, chewed or crushed, as this could affect the prolonged-release action.

Oruvail should preferably be taken with or after food.

The lowest effective dose should be used for the shortest time necessary to control symptoms.

Oruvail should not be taken with other NSAIDs unless specifically advised by your doctor.

What are the side effects?

Like other NSAIDs, Oruvail can cause side effects. These may include:

• Indigestion or stomach pain
• Nausea or vomiting
• Diarrhoea or constipation
• Headache or dizziness
• Tiredness or drowsiness
• Skin rash or itching
• Swelling caused by fluid retention

More serious side effects can include stomach ulcers or gastrointestinal bleeding, kidney or liver problems, raised blood pressure and cardiovascular problems.

Seek urgent medical attention if you vomit blood, pass black or tarry stools, develop severe breathing difficulties or swelling of the face or throat, or develop a severe skin reaction with blistering or peeling.

NSAIDs such as ketoprofen may be associated with a small increased risk of heart attack or stroke. This risk is more likely with higher doses and prolonged treatment.

Marketed by

Oruvail prolonged-release capsules are marketed in the UK by Sanofi.

Reviewed: September 2026
Version ID: 2/ORV/PAT/09/26

Pennsaid belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It contains the active ingredient diclofenac sodium and is used to relieve pain associated with osteoarthritis in superficial joints, such as the knee or wrist.

How does it work?

Diclofenac works by blocking the action of enzymes called cyclo-oxygenase (COX). These enzymes are involved in producing prostaglandins, chemicals that contribute to pain, swelling and inflammation.

When Pennsaid is applied to the skin, diclofenac passes through the skin into the tissues underneath. This allows it to act locally to reduce pain and inflammation.

Pennsaid is intended for osteoarthritis affecting superficial joints. There is no evidence for its use in large, deep joints covered by muscle or other soft tissue, such as the hip or spine.

Who can get it?

Pennsaid is available on prescription for adults.

It should not be used by people who have previously had an allergic reaction, asthma, breathing difficulties or other allergic symptoms after taking aspirin or another NSAID.

How is it used?

The painful joint should be washed with soap and water and allowed to dry before applying Pennsaid.

The usual amount is:

• 20 drops for a medium-sized joint, such as the wrist.
• 40 drops for a large joint, such as the knee.

The drops should be applied in small amounts over the painful joint and spread evenly without rubbing or massaging. Treatment is normally repeated four times a day, as directed by your doctor.

Pennsaid is for application to the skin only and must not be taken by mouth.

Do not apply it to broken, damaged, infected or diseased skin. Avoid contact with the eyes, mouth and other mucous membranes. Do not cover the treated area with an airtight dressing.

Wash your hands after applying Pennsaid, unless your hands are the area being treated.

Because some diclofenac can be absorbed into the bloodstream, side effects associated with NSAIDs can still occur, particularly if large areas are treated or the medicine is used for a prolonged period.

What are the side effects?

Possible side effects include:

• dry skin
• redness, itching or irritation where the medicine is applied
• skin rash or other skin reactions.

Systemic side effects, such as indigestion, stomach pain or other NSAID-related effects, are possible because some diclofenac is absorbed through the skin. The risk is generally lower than with oral diclofenac, but it is not completely eliminated.

Stop using Pennsaid and seek medical advice if you develop signs of an allergic reaction, severe skin reaction, stomach bleeding or other serious symptoms.

Do not use Pennsaid with another NSAID, such as ibuprofen, naproxen or diclofenac tablets, unless advised by a healthcare professional.

Pennsaid should not be used during pregnancy unless specifically advised by a doctor. NSAIDs should not be used during the last three months of pregnancy.

Marketed by

Pennsaid is marketed in the UK by Dimethaid International.

Reviewed: September 2026
Version ID: 2/PEN/PAT/09/26

This page is for reference only as this product is now discontinued

Tenoxicam is a non-steroidal anti-inflammatory drug which helps to reduce inflammation and to reduce the pain caused by arthritis

How does it work?

Tenoxicam works by blocking the production of some of the body chemicals that cause inflammation, pain, stiffness, tenderness, swelling and increased temperature.
By reducing inflammation in conditions affecting muscles and joints Tenoxicam helps to improve movement.
Tenoxicam can take a few weeks to help improve inflammation but can start to relieve pain after the first few doses.

Who can get it?

Not recommended for children

How is it used?

The usual daily dose for adults is 20mg, taken as a single tablet at the same time each day.
Tablets should be taken with water or other fluid.

What are the side effects?

Clinical studies have shown the following side effects can occur:

• Stomach upset
• Oedema, swelling of tissues
• Headache
• Rashes
• blood dyscrasias
• Raised liver enzymes
• visual disturbances
• hypersensitivity reactions
• plastic anaemia
• haemolytic anaemia
• hepatitis
• jaundice
• nephrotoxicity

Marketed by

Tenoxicam was available on prescription. It was known commercially as Mobiflex and was marketed in the UK by Meda Pharmaceuticals Ltd.

Reviewed: September 2026
Version ID: 2/TEN/PAT/09/26

Tiaprofenic acid is a non steroidal anti-inflammatory drug used for the treatment of rheumatoid arthritis, ankylosing spondylitis, osteoarthrosis, lumbago, acute musculo-skeletal disorders, soft tissue injuries.

How does it work?

Tiaprofenic acid helps to reduce inflammation and to reduce pain. Tiaprofenic acid works by blocking the production of some of the body chemicals that cause inflammation, pain, stiffness, tenderness, swelling and increased temperature.
By reducing inflammation in conditions affecting muscles and joints Tiaprofenic acid helps to improve movement.
Tiaprofenic acid can take a few weeks to help improve inflammation but can start to relieve pain after the first few doses.

Who can get it?

Tiaprofenic acid is available on prescription for adults. It is not suitable for children

How is it used?

• swallow the medicine whole with a glass of water
• take your medicine in its original form. You must not break, chew or crush it

What are the side effects?

Clinical studies have shown the following side effects can occur.

• GI upset
• Headache
• Drowsiness
• Rash
• Urinary frequency

Read reviews or write your own

If you would like to read other people’s experience of this treatment, or have any comments to share, good or bad, you might like to go to iWantGreatCare for Tiaprofenic acid or iWantGreatCare for Surgam.

Marketed by

Tiaprofenic acid is available on prescription and is commercial known as Surgam. It is marketed in the UK by Sanofi Aventis

Vimovo contains the active ingredients naproxen and esomeprazole and belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). It is used in adults to relieve the symptoms of osteoarthritis, rheumatoid arthritis and ankylosing spondylitis.

Vimovo combines naproxen with esomeprazole for people who need an NSAID and are at increased risk of developing stomach or duodenal ulcers.

How does it work?

Naproxen is an NSAID that reduces pain and inflammation by reducing the production of substances called prostaglandins.

Esomeprazole is a proton pump inhibitor (PPI). It reduces the amount of acid produced in the stomach and helps reduce the risk of stomach and duodenal ulcers associated with NSAID treatment.

Vimovo helps control symptoms but does not treat the underlying cause of arthritis or replace disease-modifying treatment where this is needed.

Who can get it?

Vimovo is available on prescription for adults.

It is not recommended for children or adolescents under 18.

Vimovo may not be suitable for people with certain stomach, heart, kidney or liver problems, or for people who have previously had an allergic reaction to aspirin or other NSAIDs. Your doctor will consider your individual risks before prescribing it.

How is it used?

Swallow the tablets whole with water. Do not chew, split or crush them, as this can affect how the medicine works.

Take Vimovo at least 30 minutes before eating. Food can delay the absorption of naproxen and may reduce the protective effect of esomeprazole.

How much to take

The usual dose is one 500 mg/20 mg tablet twice a day, for as long as your doctor recommends.

Vimovo is only available as 500 mg naproxen/20 mg esomeprazole. If this dose is not suitable, your doctor may prescribe naproxen or another NSAID at a different dose, with or without separate stomach protection.

Vimovo is not intended to provide rapid relief of acute pain because the naproxen is released slowly.

Your doctor should review your treatment regularly, particularly if you take Vimovo for a long time. The lowest effective NSAID dose should be used for the shortest time necessary.

Do not take Vimovo with other NSAIDs, such as ibuprofen, diclofenac, celecoxib or etoricoxib, unless specifically advised by your doctor.

What are the side effects?

Like all medicines, Vimovo can cause side effects, although not everybody gets them.

Possible side effects include:

• Dizziness or feeling light-headed.
• Tiredness or drowsiness.
• Nausea or vomiting.
• Diarrhoea, constipation, stomach pain, indigestion, heartburn or wind.
• Swelling of the hands, feet or ankles.
• Skin rash or itching.
• Sleep disturbance.
• Increased sweating.
• Changes in vision or hearing, such as blurred vision or ringing in the ears.
• Mouth inflammation or mouth ulcers.

Because Vimovo contains an NSAID, it can sometimes cause stomach or intestinal ulcers, bleeding or perforation, even without warning symptoms. The risk is greater with higher doses, longer treatment and in people with a previous ulcer or other risk factors. The esomeprazole component reduces the risk of ulcers but does not remove it completely.

Stop taking Vimovo and seek urgent medical attention if you develop:

• Swelling of the face, lips, tongue or throat, difficulty breathing, wheezing or difficulty swallowing.
• Vomiting blood or material that looks like coffee grounds.
• Black, tarry stools or bloody diarrhoea.
• Severe or persistent stomach pain.
• A severe skin rash, blistering or peeling of the skin, or sores in the mouth, eyes or other areas.
• Yellowing of the skin or whites of the eyes, particularly with dark urine or unusual tiredness.
• Chest pain, sudden weakness or numbness, difficulty speaking or other possible signs of a heart attack or stroke.

Vimovo can also rarely cause kidney inflammation or other kidney problems. Tell your doctor if you notice a significant reduction in the amount of urine, blood in your urine, fever, rash or joint stiffness.

Long-term treatment with esomeprazole may also affect vitamin B12 or magnesium levels in some people. Long-term use of proton pump inhibitors may slightly increase the risk of certain fractures, particularly in people who already have risk factors for osteoporosis.

Marketed by

Vimovo is marketed in the UK by Grünenthal Ltd.

Reviewed: September 2026
Version ID: 2/VIM/PAT/09/26

Volsaid Retard tablets contain the active ingredient diclofenac sodium, which is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID).

NSAIDs are used to relieve pain and inflammation. Diclofenac can be used for a range of musculoskeletal conditions, including rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, back pain, sprains and strains, tendinitis and other painful inflammatory conditions.

Volsaid Retard tablets are modified-release tablets, which release diclofenac gradually to provide longer-lasting relief.

How does it work?

Diclofenac works by blocking the action of enzymes called cyclo-oxygenase (COX). These enzymes are involved in producing substances called prostaglandins.

Prostaglandins are involved in pain, swelling and inflammation. By reducing their production, diclofenac helps relieve pain and inflammation.

Diclofenac helps control symptoms but does not treat the underlying cause of arthritis or replace disease-modifying treatment where this is needed.

Because Volsaid Retard is a modified-release preparation, the diclofenac is released gradually over several hours.

Who can get it?

Volsaid Retard is available on prescription for adults.

It may not be suitable for people who have had stomach ulcers or bleeding, certain heart or circulation problems, kidney or liver problems, or an allergic reaction to aspirin or other NSAIDs.

Diclofenac should be used at the lowest effective dose for the shortest time necessary, particularly in people with cardiovascular risk factors. Long-term treatment should be reviewed regularly.

How is it used?

Volsaid Retard tablets should be taken with or after food if possible.

• 75 mg tablets: one tablet once or twice daily.
• 100 mg tablets: one tablet once daily.

The tablets should be swallowed whole with water. Do not crush or chew them, as this can affect the modified-release action.

The total daily dose of diclofenac should generally not exceed 150 mg.

Do not take Volsaid Retard with other NSAIDs, such as ibuprofen, naproxen, aspirin for pain relief, celecoxib or etoricoxib, unless your doctor specifically advises you to do so.

What are the side effects?

Like all medicines, Volsaid Retard can cause side effects, although not everybody gets them.

Possible side effects include:

• Indigestion, stomach pain, nausea, vomiting, diarrhoea or constipation.
• Wind or loss of appetite.
• Headache or dizziness.
• Drowsiness or tiredness.
• Skin rash or itching.
• Fluid retention and swelling of the hands, feet or ankles.
• Changes in liver or kidney function.
• Changes in blood counts.

NSAIDs such as diclofenac can sometimes cause stomach or intestinal ulcers, bleeding or perforation, which can occasionally be serious or life-threatening.

Diclofenac may also increase the risk of heart attack or stroke, particularly with higher doses or long-term treatment. People with existing heart or circulation problems, high blood pressure or other cardiovascular risk factors may need particular care.

Seek urgent medical attention if you develop:

• Severe allergic symptoms such as swelling of the face, lips, tongue or throat, difficulty breathing or wheezing.
• Vomiting blood or material that looks like coffee grounds.
• Black, tarry stools or blood in your stools.
• Severe or persistent stomach pain.
• Chest pain, sudden weakness or numbness, difficulty speaking or other possible signs of a heart attack or stroke.
• A severe skin reaction, including blistering, peeling or sores in the mouth or eyes.
• Yellowing of the skin or whites of the eyes, particularly with dark urine or unusual tiredness.
• A significant reduction in the amount of urine or other signs of serious kidney problems.

Marketed by

Volsaid Retard is marketed in the UK by Chiesi Ltd

Reviewed: September 2026
Version ID: 2/VOL/PAT/09/26

Voltarol contains diclofenac, a type of medicine called a non-steroidal anti-inflammatory drug (NSAID). NSAIDs are used to relieve pain and inflammation.

Voltarol products are used for a range of painful conditions, including some types of arthritis, musculoskeletal pain and inflammation. Different Voltarol products contain different forms of diclofenac and are used in different ways.

How does it work?

Diclofenac works by blocking enzymes called cyclo-oxygenase (COX). These enzymes are involved in producing substances called prostaglandins.

Prostaglandins are produced by the body in response to injury and certain diseases and contribute to pain, swelling and inflammation. By reducing the production of prostaglandins, diclofenac helps relieve pain and inflammation.

Diclofenac can be used for conditions including rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, acute gout and acute musculoskeletal problems such as tendinitis, bursitis, frozen shoulder, sprains, strains and back pain. It can also be used for pain following some dental, orthopaedic and other minor surgery.

Diclofenac helps control symptoms but does not treat the underlying cause of arthritis or replace disease-modifying treatment where this is needed.

Voltarol tablets and other formulations

Voltarol Rapid 50 mg tablets contain diclofenac potassium. They are absorbed relatively quickly and are used for short-term relief of pain and inflammation. The tablets should be swallowed whole with water.

The older Voltarol enteric-coated, dispersible, SR and Retard tablets described in some older information are not currently listed as UK Voltarol tablet products on the eMC. Current UK Voltarol products also include suppositories and ampoules containing diclofenac sodium.

Who can get it?

Voltarol is available on prescription for adults, although the age and suitability of treatment depend on the particular formulation.

Diclofenac may not be suitable for people who have had stomach ulcers or bleeding, certain heart or circulation problems, kidney or liver problems, or allergic reactions to aspirin or other NSAIDs.

Systemic diclofenac should be used with particular caution in people with cardiovascular risk factors. It is contraindicated in people with established ischaemic heart disease, peripheral arterial disease, cerebrovascular disease or congestive heart failure.

How is it used?

The dose and method of taking Voltarol depend on the particular product.

For systemic diclofenac, the lowest effective dose should be used for the shortest time necessary to control symptoms.

Do not take Voltarol tablets with other NSAIDs, such as ibuprofen, naproxen, celecoxib or etoricoxib, unless your doctor specifically advises you to do so.

If you are prescribed a tablet formulation, follow the instructions supplied with your particular product. Some formulations have special coatings or modified-release properties and must be swallowed whole.

What are the side effects?

Like all medicines, Voltarol can cause side effects, although not everybody gets them.

Possible side effects include:

• Indigestion, stomach pain, nausea, vomiting, diarrhoea or constipation.
• Wind or loss of appetite.
• Headache or dizziness.
• Drowsiness or tiredness.
• Skin rash or itching.
• Fluid retention and swelling of the hands, feet or ankles.
• Changes in liver or kidney function.
• Changes in blood counts.

NSAIDs such as diclofenac can sometimes cause stomach or intestinal ulcers, bleeding or perforation, which can occasionally be serious or life-threatening.

Systemic diclofenac can also increase the risk of heart attack or stroke, particularly with higher doses and longer treatment. Your doctor will consider your cardiovascular risk before prescribing it.

Seek urgent medical attention if you develop:

• Swelling of the face, lips, tongue or throat, difficulty breathing or wheezing.
• Vomiting blood or material that looks like coffee grounds.
• Black, tarry stools or blood in your stools.
• Severe or persistent stomach pain.
• Chest pain, sudden weakness or numbness, difficulty speaking or other possible signs of a heart attack or stroke.
• A severe skin reaction, including blistering, peeling or sores in the mouth or eyes.
• Yellowing of the skin or whites of the eyes, particularly with dark urine or unusual tiredness.
• A significant reduction in the amount of urine or other signs of serious kidney problems.

Marketed by

Voltarol products are marketed in the UK by Novartis Pharmaceuticals UK Ltd. Current UK Voltarol products include Voltarol Rapid tablets, suppositories and ampoules.

Reviewed: September 2026
Version ID: 2/VOT/PAT/09/26