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

Aceclofenac belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs) and it is used in the treatment of osteoarthritis, rheumatoid arthritis and ankylosing spondylitis.

How does it work?

It works by blocking the action of a substance in the body called cyclo-oxygenase. Cyclo-oxygenase is involved in the production of various chemicals in the body, some of which are known as prostaglandins. Prostaglandins are produced in response to injury or certain diseases and would otherwise go on to cause pain, swelling and inflammation. Arthritic conditions are one example of this. Aceclofenac is used to relieve pain and inflammation in arthritic conditions. All the medicines in this group reduce inflammation caused by the body's own immune system and are effective pain killers.

Who can get it?

Aceclofenac is a prescription only medicine (POM) and is not suitable for children. It should be used with caution in patients who are allergic to aspirin or any other NSAIDs (such as ibuprofen, naproxen or diclofenac), who have a history of stomach ulcers or intestinal bleeding, who have moderate to severe kidney disease, who have suspected liver failure, or who are pregnant.

How is it used?

The recommended dose in adults is 200 mg per day, taken as one tablet in the morning and one in the evening.

Tables should be swallowed whole with a drink of water. The tables should not be crushed or chewed the tablets.

Take preferably with or after food.

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.

Common side effects (occur in more than 1 in 100 patients but in less than 1 in 10 patients):

• dizziness
• nausea (feeling sick)
• diarrhoea
• increased liver enzymes in the blood

Uncommon (occur in more than 1 in 1,000 patients but in less than 1 in 100 patients):

• wind (flatulence)
• inflammation or irritation of the lining of the stomach (gastritis)
• constipation
• vomiting
• mouth ulcers
• itching
• rash
• inflammation of the skin (dermatitis)
• raised circular red itchy, stinging or burning patches on the skin (hives)
• increase in blood urea levels
• increase in blood creatinine levels

Rare (occur in more than 1 in 10,000 patients but in less than 1 in 1,000 patients):

• low levels of iron in the blood
• hypersensitivity (allergic reaction)
• visual disturbance
• shortness of breath

Very Rare (occur in less than 1 in 10,000 patients):

• low white blood cells levels
• low platelets levels in the blood
• abnormal breakdown of red blood cells (anemia)
• high potassium levels in the blood
• depression
• strange dreams
• inability to sleep
• tingling, pricking or numbness of skin
• uncontrollable shaking (tremor)
• drowsiness
• headaches
• abnormal taste in the mouth
• sensation of spinning when standing still
• heart pounding or racing (palpitations)
• hot flushes
• difficulty breathing
• high pitched noise when breathing
• inflammation of the mouth
• stomach ulcer
• inflammation of the pancreas (pancreatitis)
• inflammation of the liver (hepatitis)
• yellowing of the skin (jaundice)
• spontaneous bleeding into the skin (appears as a rash)
• blisters
• water retention and swelling
• tiredness
• leg cramps
• increased blood alkaline phosphatase levels
• weight gain

Aceclofenac should not be taken with any other NSAID, due to an increased risk of side effects.

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

Arthrotec belongs to the group of medicines which are known as non-steroidal anti-inflammatory drugs (NSAIDs) and is made up from the active ingredients of Diclofenac and Misoprostol. It is used for the relief of pain caused by Rheumatoid arthritis & osteoarthritis.

How does it work?

It works by blocking the production of a group of chemicals (prostaglandins) that are normally produced by the body in response to injury or certain diseases. These prostaglandins would otherwise go on to cause swelling, pain and inflammation. By blocking prostaglandins, diclofenac relieves swelling, pain and inflammation.
However, prostaglandins also play a role in protecting the stomach lining. They reduce the amount of acid produced by the stomach, and increase bicarbonate and mucus secretion in the gut. This promotes protection of the lining of the gut and relief of symptoms due to excess acid in the gut. Therefore, the reduction of prostaglandin levels by diclofenac may result in excess gut acid and may damage the gut lining (ulcers).

Misoprostol works by mimicking the action of prostaglandin and so counteracts the adverse effects on the gut, which could be caused by use of diclofenac.

The combination is particularly useful for individuals requiring diclofenac, who also have a special need to prevent the associated adverse effect on the gut.

Who can get it?

This medicine is only suitable for those over the age of 18.

How is it used?

Take 50 mg tablets two to three times daily or 75 mg tablet twice daily, both taken with food.

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.

• Headache
• Dizziness or loss of balance
• Tiredness
• Blood disorders
• Skin rashes
• Decreased kidney function
• Retention of water in the body tissues (fluid retention)
• Alteration in results of liver function tests
• Vaginal bleeding
• Gastric disturbances including nausea, vomiting, gastric discomfort, constipation, diarrhoea
• Hypersensitivity reactions such as narrowing of the airways (bronchospasm), swelling of the lips, throat and tongue (angioedema) or severe skin reaction (toxic epidermal necrolysis)
• Change in menstrual bleeding

This medicine may cause dizziness and so may affect your ability to drive or operate machinery safely. Do not drive or operate machinery until you know how this medicine affects you and you are sure it won't affect your performance.
This medicine should not be used by pre-menopausal women unless they are using effective contraception.
It is recommended that people taking this medicine for long periods of time have regular blood tests to monitor the levels of the different types of blood cells in the blood.

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Arthrotec is marketed in the UK by Pfizer Ltd

Aspirin belongs to the group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs) and is used for the treatment of Rheumatism, rheumatoid arthritis, prolonged pain.

How does it work?

It works by blocking the action of a substance in the body called cyclo-oxygenase.

Cyclo-oxygenase is involved in the production of various chemicals in the body. These are known as prostaglandins, prostacyclins and thromboxane.

With high doses of aspirin, e.g. 300mg, the blocking of cyclo-oxygenase prevents the production of prostaglandins. Prostaglandins are produced in response to injury or certain diseases and would otherwise go on to cause pain, swelling and inflammation. High doses of aspirin are therefore used to relieve pain and inflammation.

Who can get it?

Children under 16 years of age should not take aspirin, unless on the advice of a doctor. This is because aspirin use in children has been associated with a rare condition called Reye's syndrome. This condition affects the brain and liver and though extremely rare, can be fatal. The causes of Reye's syndrome are not fully understood, but use of aspirin to treat fever in children with a virus has been implicated.

How is it used?

The recommended dose in adults is 300—900 mg three or four times daily; maximum dose is 4 g daily.

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.

• Nausea
• Blood disorders
• Sensation of ringing, or other noise in the ears (tinnitus)
• Allergic reactions such as skin rash, swelling of the lips, tongue and throat (angioedema) or narrowing of the airways (bronchospasm)
• Increased bleeding time
• Ulceration or bleeding of the stomach or intestines
• Stomach or intestinal discomfort
• Worsening of asthma
• Indigestion (dyspepsia)

Aspirin reduces the rate at which the body can remove the medicine methotrexate. The two should not usually be used together.

There is an increased risk of side effects if aspirin is taken with other non-steroidal anti-inflammatory drugs (NSAIDs), e.g. ibuprofen, diclofenac, indomethacin. For this reason, aspirin should not be taken with any other NSAID. Low-dose aspirin used for anti-blood-clotting purposes is an exception to this, but should only be used with other NSAIDs on the instruction of a doctor.

There may be an increased risk of bleeding or ulceration of the stomach or intestines if aspirin is taken with corticosteroids, e.g. prednisolone, dexamethasone.

There may be an increased risk of side effects if aspirin is taken with acetazolamide.

Antacids (indigestion remedies) should not be taken at the same time as enteric-coated aspirin.

How do I get Aspirin?

Aspirin is available over the counter from your local pharmacy under various names.

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

Brufen contains the active ingredient ibroprofen which is a type of medicine called a non-steroidal anti-inflammatory drug NSAID. Ibuprofen is a simple painkilling medicine used to relieve mild to moderate pain, inflammation and fever. It can relieve symptoms from rheumatoid arthritis, juvenile rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, seronegative arthropathies, peri-articular disorders, soft tissue injuries.

How does it work?

Ibuprofen 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 in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. NSAIDs block the production of these prostaglandins and are therefore effective at reducing inflammation and pain.

Ibuprofen also reduces fever by reducing the production of prostaglandins. Fever is associated with an increase in prostaglandins in the brain, and these prostaglandins cause the body temperature to increase. By reducing prostaglandins in the brain, ibuprofen lowers body temperature and hence reduces fever.

Ibuprofen reduces inflammation and related pain and so can be used to relieve muscular and rheumatic aches and pains. It can also be used to relieve other painful conditions such as headaches, migraine, toothache, nerve pain (neuralgia) and period pain. It is also useful for reducing fever, and Brufen syrup can be used for reducing fever in children.

Brufen retard tablets are sustained-release tablets. They are designed to release the ibuprofen slowly and continuously over a few hours to provide prolonged pain relief. These tablets must be swallowed whole to avoid damaging the sustained-release action.

Brufen should preferably be taken with food to avoid irritating the stomach.

Who can get it?

Available on prescription for adults and children (not recommended for children weighing less than 7kg).

How is it used?

Dosage for adults: Take 2 tablets in the early evening. For severe or acute conditions, take 3 tablets daily in two divided doses.

Dosage for children: 20mg/kg of body weight in divided doses or up to 40mg/kg for juvenile RA.

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 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 upset or haemorrhage,
• rash,
• thrombocytopenia

Please read the patient information leaflet for further details.

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Ibuprofen is marketed in the UK by Abbott Laboratories Ltd and is known commercially as Brufen and Brufen Retard. Unbranded versions are also available.

Celecoxib helps to reduce inflammation and to reduce pain. Celecoxib 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 Celecoxib helps to improve movement.
Celecoxib can take a few weeks to help improve inflammation but can start to relieve pain after the first few doses.

Who can get it?

Celecoxib is available on prescription although you should speak to your doctor if you:

• are a child
• are a woman who could become pregnant and who is not using an effective method of birth control
• are allergic to any of the ingredients in the medicine
• are breast-feeding
• are elderly
• are pregnant
• are prone to gastrointestinal problems
• are suffering from dehydration
• have had an allergy to any medicine in the past
• have heart problems
• have high blood pressure or other risk factors for heart problems such as high levels of cholesterol, diabetes or smoking
• have inflammatory bowel disease
• have kidney problems
• have liver problems

How is it used?

swallow the medicine whole with a glass of water
this medicine can be taken with or without food. If taken with food, it may delay the effects of Celecoxib by up to an hour

What are the side effects?

In studies the most common reported side effects are:

• diarrhoea
• dizziness
• flatulence
• fluid retention
• indigestion
• oedema of the extremities
• pharyngitis
• rhinitis
• sinusitis
• skin or hypersensitivity reactions
• sleeping problems
• stomach pain
• upper respiratory tract infections

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Celecoxib is known commercially as Celebrex and is marketed in the UK by Pfizer Ltd

Dexibuprofen is for the treatment of pain and inflammation associated with osteoarthritis and other musculoskeletal disorders. It belongs to the group of drugs known as non-steroidal anti inflammatory drugs. (NSAIDS)

How does it work?

Dexibuprofen helps to reduce inflammation and to reduce pain. Dexibuprofen 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 Dexibuprofen helps to improve movement.
Dexibuprofen can take a few weeks to help improve inflammation but can start to relieve pain after the first few doses.

Who can get it?

Dexibuprofen must not be administered in the following cases:

• Patients previously sensitive to dexibuprofen, to any other NSAID, or to any of the excipients of the product.
• Patients in whom substances with a similar action (e.g. aspirin or other NSAIDs) precipitate attacks of asthma, ronchospasm, acute rhinitis, or cause nasal polyps, urticaria or angioneurotic oedema.
• Patients with active or suspected gastrointestinal ulcer or history of recurrent gastrointestinal ulcer.
• Patients who have gastrointestinal bleeding or other active bleedings or bleeding disorders.
• Patients with active Crohn's disease or active ulcerative colitis.
• Patients with severe heart failure.
• Patients with severe renal dysfunction (GFR < 30ml/min).
• Patients with severely impaired hepatic function.
• Patients with haemorrhagic diathesis and other coagulation disorders, or patients receiving anticoagulant therapy.
• From the beginning of 6th month of pregnancy

How is it used?

The normal dose is 300 mg up to three times a day. Your doctor may also prescribe tablets with higher or lower strength.
400 mg tablets may be prescribed in acute situations or during the start of therapy.
200 mg tablets may be used in special patient groups, such as the elderly, or in the treatment of mild to moderate pain.
For the treatment of mild to moderate pain, initially single doses of 200 mg dexibuprofen and daily doses of 600 mg dexibuprofen are recommended.
Do not take more than 1200 mg a day. The maximum single dose is 400 mg.

What are the side effects?

In clinical studies the most common side effects are:
Nausea, vomiting, abdominal pain, skin rash, fatigue or drowsiness, dizziness or giddiness, headache.

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Dexibuprofen is available on prescription and is commercially known as Seractil and is marketed in the UK by Genus Pharmaceuticals.

Dexketoprofen belongs to the group of medicines known as non-steroidal anti-inflammatory drugs (NSAIDs).
Dexketoprofen can be used short-term to relieve mild to moderate pain caused by rheumatic and muscular disorders and period (menstrual) pain.

How does it work?

Dexketoprofen works by preventing the production of irritant chemicals that cause pain and inflammation in the body

Who can get it?

Care should be taken if you have a history of bronchial asthma or allergic disease, SLE, mixed connective tissue disease, cardiac impairment, mild to moderate hepatic impairment, mild renal impairment. Not recommended for children
Care should also be taken if:

• if you are pregnant, trying for a baby or breast-feeding
• if you suffer from liver, kidney or heart problems
• if you suffer from hypertension (high blood pressure) or systemic lupus erythematosus
• if you suffer from rhinitis, asthma or breathing problems
• if you have ever had an unusual reaction from taking aspirin or NSAIDs
• if you get indigestion, heart burn or any other digestive or bowel problems
• if you have ever suffered from peptic (stomach) ulcer
• if you have ever had blood clotting problems
• if you have ever had an allergic reaction to this or any other medicine
• if you are taking any other medicines, including those available to buy without a prescription, herbal and complementary medicines

How is it used?

The recommended dose is 12•5 mg every 4—6 hours. or 25 mg every 8 hours. In acute pain, take 30 minutes before meals; maximum dosage 75 mg daily. (1)

What are the side effects?

In studies the most common reported side effects are:

• GI intolerance
• Headache
• Dizziness
• haematological effects

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Dexketoprofen is known commercially as Keral and is marketed in the UK by A. Menarini Pharma UK SRL.

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). NSAIDs are used to relieve pain and inflammation caused by musculo-skeletal disorders, sprains, strains, back pain, rheumatoid arthritis, osteoarthritis and ankylosing spondylitis.

How does it work?

Diclofenac 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. Diclofenac blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.

Diclofenac is used to relieve pain and inflammation in a wide range of musculoskeletal conditions, including various forms of arthritis, gout, sprains, fractures, dislocations, back pain, tendonitis, tenosynovitis, bursitis? and frozen shoulder. It is also used to relieve pain and inflammation following dental, orthopaedic (joints/bone) and other minor surgery.

Diclomax SR capsules and Diclomax Retard capsules are sustained-release capsules. They are designed to release the diclofenac slowly and continuously over a few hours. This provides prolonged pain relief, so the capsules are usually taken once (Retard) or twice (SR) a day. These capsules must be swallowed whole to avoid damaging the sustained-release action.

Both types of capsule should preferably be taken with food to help avoid irritating the stomach.

Who can get it?

Available on prescription for those over the age of 18.

How is Diclomax taken?

Diclomax SR

Adults: The normal dose is one or two 75mg capsules daily with or after food.
Children: Diclomax SR is not recommended for children.

Diclomax Retard

Adults: The normal dose is one capsule daily with or after food.
Children: Diclomax Retard is not recommended for children.

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 NSAIDs. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

• Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain
• Indigestion (dyspepsia)
• Excess gas in the stomach and intestines (flatulence)
• Loss of appetite
• Headache
• Dizziness
• Balance disorders involving the inner ear (vertigo)
• Skin rashes
• Ulceration of the stomach or intestine
• Bleeding from the stomach or intestine
• Allergic reactions such as skin rashes, swelling of the lips, tongue and throat (angioedema) or narrowing of the airways (bronchospasm)
• Drowsiness
• Fluid retention (oedema)
• Kidney, liver or blood disorders

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Diclomax is marketed in the UK by Galen Ltd.

Difflam contains the active ingredient benzydamine hydrochoride which belongs to the group of medicines known as non-steroidal anti-inflammatory drug (NSAID). It is used to treat pain caused by backache, rheumatic and muscular pain, sprains, strains, and neuralgia.

How does it work?

Benzydamine works by preventing the formation of prostaglandins. Prostaglandins are produced by the body and are responsible for inflammation features, such as swelling, pain, stiffness, redness and warmth.
 
Benzydamine also acts as a local anaesthetic, causing numbness and so pain relief at the site of application.

Who can get it?

Available for both adults and children from a pharmacy.

How is it used?

1-2 g of difflam should be massaged in lightly three times daily.  In severe cases up to six times daily.  The cream should not be used for more than 10 days

What are the side effects?

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

You may experience any of the following
•    Itching
•    Skin rash
•    Skin redness or swelling
•    Difficulty breathing and wheezing
Some people become more sensitive to the effects of sunlight after using this cream.  This means that the skin may become red and painful after only a few minutes in the sun.  These side effects should disappear if you stop using the cream.

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Difflam is marketed in the UK by Meda

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.

Felbinac is a type of medicine known as a non-steroidal anti-inflammatory drug (NSAID) used for the treatment of rheumatic and mild arthritic pain, sprains, strains and other soft tissue injuries

How does it work?

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

All the medicines in this group reduce inflammation caused by the body's own immune system and are effective pain killers.

Felbinac is applied to the skin surface (topically) for the relief of local pain and inflammation. It is used in many muscular and joint conditions such as in sprains, strains, rheumatism, and mild arthritic conditions.

The gel form of this medicine may be used in ultrasound as a coupling agent.

Who can get it?

Available on prescription for those over the age of 18.

How is it used?

Gently rub 1 g of gel or golf ball sized quantity of foam into affected area 2—4 times daily; maximum 25 g daily.
You should not cover the area being treated with airtight dressings such as bandages or other dressings, including nappies, as these will enhance the absorption of the medicine into the body and may increase the risk of adverse effects.
Avoid contact of this medicine with the eyes and the moist membranes lining the inside of certain parts of the body, e.g. mouth, nasal passages (mucous membranes). Rinse with cold water if accidental contact occurs.
Wash your hands thoroughly after applying this medicine, unless the hands are the area being treated.
The foam preparation is inflammable. Keep away from naked flames.

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.

• Mild local erythema,
• dermatitis,
• pruritus,
• paraesthesia

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

Feldene contains the active ingredient piroxicam, which is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID). NSAIDs are used to relieve pain and inflammation as seen in rheumatoid arthritis and osteoarthritis.

How does it work?

Piroxicam 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. Piroxicam blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.
Piroxicam is used to relieve pain and inflammation in a wide range of musculoskeletal conditions, including various forms of arthritis, gout and muscle sprains and strains. It is also used to relieve pain and inflammation following orthopaedic (bone), dental and other minor surgery.

Piroxicam has a prolonged duration of action which means that one dose can provide pain relief throughout the day. You should try and take your dose at the same time each day.
Feldene capsules should be swallowed with a drink. Feldene dispersible tablets are designed to be dissolved in water before taking, but can also be swallowed whole with a drink. Feldene melt tablets are designed to dissolve quickly on the tongue and be swallowed with your saliva. These are convenient to take if you don't have a drink handy. They can also be swallowed whole with a drink. All these dose forms should preferably be taken with food to help reduce irritation to the stomach.
Feldene injection may be given for the initial relief of pain, but you will be switched onto oral treatment as soon as possible. The injection is given into the muscle of the buttock.

Who can get it?

This medicine is available on prescription for adults.

How is it used?

20mg each day. This dose may be decreased to 10mg each day (especially for elderly patients) or increased to 30mg each day. See the label on the pack to find out what dose you should take.
As your medicine helps to relieve the painful symptoms of arthritis it is usual for it to be taken for long periods of time. (Doses above 20mg daily for more than several days carry an increased risk of effects on the digestive system).

What are the side effects?

Effects on digestive system including:

• diarrhoea or constipation, wind.
• nausea, vomiting, loss of appetite.
• sore mouth and/or lips.
• stomach ache, indigestion, abdominal pain/discomfort.
• stomach (peptic) ulcers.

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Feldene is marketed in the UK by Pfizer Ltd.

Fenbid Gel contains the active ingredient ibuprofen which belongs to the group of medicines known as non-steroidal anti-inflammatory drug (NSAID). It is used to treat pain caused by backache, rheumatic and muscular pain, sprains, strains, and neuralgia.

How does it work?

Ibuprofen 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 in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. NSAIDs block the production of these prostaglandins and are therefore effective at reducing inflammation and pain.

When ibuprofen is applied to the skin (topical application) it is absorbed through the skin into the underlying tissues, where it reduces pain and inflammation in the local area.

Fenbid gel and Fenbid forte gel can be used to relieve the pain of muscular and joint conditions such as sprains, strains, backache, rheumatism and minor arthritic conditions. They should be massaged gently into the affected area.

Ibuprofen is absorbed less into the bloodstream from preparations that are applied to the skin than from preparations that are taken by mouth (see end of factsheet), however absorption can still occur, particularly if large amounts are used on large areas.

Who can get it?

Available over the counter from most good chemists for adults and children over the age of 14.

How is it used?

For topical application over the affected area.
Massage in three to four times each day.

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.

• Skin rashes
• Abdominal pain
• Indigestion (dyspepsia)
• Allergic reactions such as asthma, narrowing of the airways (bronchospasm), swelling of the lips, throat and tongue (angioedema), itchy blistering rash or anaphylactic shock

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Fenbid Gel is marketed in the UK by Goldshield Pharmaceuticals Ltd

Fenbid contains the active ingredient ibroprofen which is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID). Ibuprofen is a simple painkilling medicine used to relieve mild to moderate pain, inflammation and fever. It can relieve symptoms from rheumatoid arthritis, juvenile rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, seronegative arthropathies, peri-articular disorders, soft tissue injuries.

How does it work?

Ibuprofen 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 in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. NSAIDs block the production of these prostaglandins and are therefore effective at reducing inflammation and pain.

Ibuprofen also reduces fever by reducing the production of prostaglandins. Fever is associated with an increase in prostaglandins in the brain, and these prostaglandins cause the body temperature to increase. By reducing prostaglandins in the brain, ibuprofen lowers body temperature and hence reduces fever.

Ibuprofen reduces inflammation and related pain and so can be used to relieve muscular and rheumatic aches and pains. It can also be used to relieve other painful conditions such as headaches, migraine, toothache, nerve pain (neuralgia) and period pain. It is also useful for reducing fever.

Fenbid spansules are sustained-release capsules. They are designed to release the ibuprofen slowly and continuously over a few hours to provide prolonged pain relief. These capsules must be swallowed whole to avoid damaging the sustained-release action.

Who can get it?

Available on prescription for adults.

How is it used?

Initially take 2 tablets twice daily increasing to 3 tablets twice daily if necessary

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 upset or haemorrhage,
• rash,
• thrombocytopenia

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Fenbid is marketed in the UK by Goldshield Pharmaceuticals Ltd

Fenoprofen is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID). NSAIDs are used to relieve pain and inflammation. Fenoprofen is used to relieve mild to moderate pain in conditions such as rheumatoid arthritis, osteoarthritis, ankylosing spondylitis.

How does it work?

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

Who can get it?

Available on prescription for those over the age of 18.

How is it used?

300—600 mg three or four times daily with a maximum of 3 g daily
Take this medication with or after food

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,
• allergies,
• hepatic and renal disorders,
• blood dyscrasias

Fenoprofen may enhance the effect of the following medicines, resulting in an increased risk of side-effects or toxicity: baclofen, ciclosporin, digoxin, lithium, methotrexate, phenytoin, quinolone antibiotics, zidovudine and blood-thinning or anti-clotting medicines.

Fenoprofen may also enhance the effect of antidiabetic tablets (belonging to the sulphonylurea group), which could lead to low blood sugar levels.

The effect of fenoprofen may be enhanced by the following medicines, resulting in an increased risk of side-effects or toxicity: moclobemide, oxpentifylline, probenecid, ritonavir and steroids.

The effect of water tablets (diuretics) and blood pressure lowering agents may be reduced by fenoprofen, resulting in their being less effective.

Use of fenoprofen with diuretics or ACE inhibitors may increase the risk of kidney problems and/or an altered potassium balance.

NSAIDs should not be used within 8-12 days of taking mifepristone.

Fenoprofen should not be taken with another NSAID.

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

Flurbiprofen belongs to a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs) and is used to treat pain caused by rheumatoid disease, osteoarthritis, ankylosing spondylitis, acute musculoskeletal disorders.

How does it work?

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

Who can get it?

Available on prescription for those over the age of 18.

How is it used?

1 slow release tablet to be taken daily preferably in the evening after food

What are the side effects?

Medicines and their possible side effects can affect individual people in different ways. The following are some of the common 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 upset,
• rash,
• rarely jaundice,
• thrombocytopenia

Flurbiprofen may enhance the effect of the following medicines, resulting in an increased risk of side-effects or toxicity: baclofen, ciclosporin, lithium, methotrexate, phenytoin, quinolone antibiotics, zidovudine and blood-thinning or anti-clotting medicines.

Flurbiprofen may also enhance the effect of antidiabetic tablets (belonging to the sulphonylurea group), which could lead to low blood sugar levels.

The effect of flurbiprofen may be enhanced by the following medicines, resulting in an increased risk of side-effects or toxicity: moclobemide, oxpentifylline, probenecid, ritonavir and steroids.

The effect of water tablets (diuretics) and blood pressure lowering agents may be reduced by flurbiprofen, resulting in their being less effective.

Use of flurbiprofen with diuretics or ACE inhibitors may increase the risk of kidney problems and/or an altered potassium balance.

NSAIDs should not be used within 8-12 days of taking mifepristone.

Flurbiprofen should not be taken with another NSAID.

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Flurbiprofen is marketed in the UK by Abbott Laboratories Ltd and is known commercially as Froben SR

Ibugel contains the active ingredient ibuprofen which belongs to the group of medicines known as non-steroidal anti-inflammatory drug (NSAID). It is used to treat pain caused by backache, rheumatic and muscular pain, sprains, strains, and neuralgia.

How does it work?

Ibuprofen 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 in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. NSAIDs block the production of these prostaglandins and are therefore effective at reducing inflammation and pain.

When ibuprofen is applied to the skin (topical application) it is absorbed through the skin into the underlying tissues, where it reduces pain and inflammation in the local area. Ibugel and Ibugel forte are aqueous/alcoholic gels, which also has an immediate cooling and soothing effect when applied to the affected area.

Ibugel can be used to relieve the pain of muscular and joint conditions such as sprains, strains, backache, rheumatism and minor arthritic conditions. It should be massaged gently into the affected area.

Ibuprofen is absorbed less into the bloodstream from preparations that are applied to the skin than from preparations that are taken by mouth however absorption can still occur, particularly if large amounts are used on large areas

Who can get it?

Ibugel is available in two strengths. 5% and 10%. The 5% strength can be bought over the counter or prescribed on NHS prescription whereas the stronger preparation can only be supplied on prescription.

How is it used?

For topical application over the affected joints.
Massage in three times each day.

What are the side effects?

None, However it should not be used in the following circumstances

• Broken, damaged, infected or diseased skin
• People in whom aspirin or other medicines in this class (NSAIDs), cause attacks of asthma, itchy rash (urticaria) or nasal inflammation (rhinitis)

Ibugel and Ibugel forte are not recommended for children under 12 years of age unless instructed by a doctor.
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.

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Ibugel is marketed in the UK by Dermal Laboratories Ltd.

Ibumousse contains the active ingredient ibuprofen which belongs to the group of medicines known as non-steroidal anti-inflammatory drug NSAID). It is used to treat pain caused by backache, rheumatic and muscular pain, sprains, strains, and neuralgia.

How does it work?

Ibuprofen 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 in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. Ibuprofen blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.

When ibuprofen is applied to the skin (topical application) it is absorbed through the skin into the underlying tissues, where it reduces pain and inflammation in the local area.

Ibumousse can be used to relieve the pain of muscular and joint conditions such as sprains, strains, backache, rheumatism and minor arthritic conditions. It should be massaged gently into the affected area.

Ibuprofen is absorbed less into the bloodstream from preparations that are applied to the skin than from preparations that are taken by mouth however absorption can still occur, particularly if large amounts are used on large areas.

Who can get it?

Ibumousse is available on NHS prescription and can be bought over the counter from most good chemists for adults.
Not suitable for children

How is it used?

For topical application over the affected area.
Massage in three to four times each day.

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.

•  Skin rashes
•  Abdominal pain
•  Indigestion (dyspepsia)
•  Allergic reactions such as asthma, narrowing of the airways (bronchospasm), swelling of the lips, throat and tongue (angioedema), itchy blistering rash or anaphylactic shock

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Ibumousse is marketed in the UK by Dermal Laboratories Ltd.

Ibuspray contains the active ingredient ibuprofen which belongs to the group of medicines known as non-steroidal anti-inflammatory drug (NSAID). It is used to treat pain caused by backache, rheumatic and muscular pain, sprains, strains, and neuralgia.

How does it work?

Ibuprofen 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 in response to injury and certain diseases and conditions, and cause pain, swelling and inflammation. Ibuprofen blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.

When ibuprofen is applied to the skin (topical application) it is absorbed through the skin into the underlying tissues, where it reduces pain and inflammation in the local area.

Ibuspray can be used to relieve the pain of muscular and joint conditions such as sprains, strains, backache, rheumatism and minor arthritic conditions. It should be massaged gently into the affected area.

Ibuprofen is absorbed less into the bloodstream from preparations that are applied to the skin than from preparations that are taken by mouth, however absorption can still occur, particularly if large amounts are used on large areas.

Who can get it?

Ibuspray is available on NHS prescription and can be bought over the counter from most good chemists for adults.
Not suitable for children

How is it used?

For topical application over the affected joint.
5—10 sprays to affected area 3 to 4 times daily.

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.

• Skin rashes
• Abdominal pain
• Indigestion (dyspepsia)
• Allergic reactions such as asthma, narrowing of the airways (bronchospasm), swelling of the lips, throat and tongue (angioedema), itchy blistering rash or anaphylactic shock

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Ibuspray is marketed in the UK by Dermal Laboratories Ltd.

Lodine SR 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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Lodine SR is marketed in the UK by Almirall Ltd

Mefenamic acid is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID) used to treat mild to moderate pain caused by rheumatoid arthritis and osteoarthritis.

How does it work?

Mefenamic acid 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. Mefenamic acid blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.

Mefenamic acid may also work by preventing the action of prostaglandins after they have already been formed.

Mefenamic acid is used to relieve pain and inflammation in a wide range of musculoskeletal conditions, including rheumatoid arthritis, muscular pain and traumatic pain such as sprains, fractures and dislocations.

Who can get it?

Available on prescription for adults.

How is it used?

The usual adult dose is 500 mg three times daily

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,
• skin rash (discontinue).
• Renal impairment,
• allergic glomerulonephritis.
• Blood dyscrasias (rare).
• Raised liver enzymes.

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Mefenamic acid is known commercially as Ponstan Capsules and Ponstan forte Tablets and is marketed in the UK by Chemidex Pharma Ltd.

Motifene contains the active ingredient diclofenac. Diclofenac is a NSAID/analgesic (painkiller) and can be used for the treatment of pain and inflammation due to:

Acute attacks of gout, acute musculo-skeletal disorders, dental or other minor surgery, joint disorders, traumatic conditions and lower back pain.

How does it work?

Diclofenac 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. Diclofenac blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.
Motifene capsules contain 25mg of diclofenac as enteric-coated pellets and 50mg of diclofenac as sustained-release pellets. Some of the pellets contained in the capsule release diclofenac quickly to give a rapid effect. The remainder of the pellets dissolve more slowly to produce a longer lasting effect.
The enteric-coated pellets have a special coat that is designed to prevent the absorption of the diclofenac in the stomach, and thus reduce the risk of stomach irritation. When the capsule reaches the intestine, these pellets dissolve and the diclofenac is absorbed into the bloodstream. This provides the initial pain relief.

The sustained-release pellets are designed to release their diclofenac slowly and continuously over a few hours. This provides more prolonged pain relief. The capsules are usually taken once a day. They must be swallowed whole to avoid damaging the pellets.

Who can get it?

Available on prescription for those over the age of 18.

How is it used?

Take 1 capsule daily in the morning before food. Increase if necessary to 1 twice daily taken at 8—12 hourly intervals

What are the side effects?

The most common side effects are related to the gut: stomach ulcer or duodenal ulcer, bleeding from the stomach or intestines (eg passing tarry stools) vomiting blood or dark particles that look like coffee grounds, stomach pa8in, indigestion, heartburn, sickness, feeling sick, flatulence, diarrhoea, constipation, worsening of Crohn’s disease or of ulcerative colitis.

Allergic reactions (such as difficulty breathing, swelling of the face, mouth and/or larynx (voice box), rashes, itching) have been reported.
Swelling of the feet or ankles has also been reported.

Other less common side effects include kidney problems, urinary problems (eg any change in the usual amount or colour of the urine), liver problems, jaundice (yellowing of the skin or whites of the eyes) blurred vision, double vision, headache, pins and needles, stiff neck, depression, confusion, hallucinations, tinnitus (ringing in the ears), dizziness or giddiness, feeling unwell, tiredness, sleepiness, sensitivity to light, rashes and spots, changes in blood test results.

If you experience any of the above tell your doctor.

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

Nabumetone is a non acidic non steroidal anti inflammatory agent which is a relatively weak inhibtor of prostaglandin synthesis which is used in osteoarthritis and rheumatoid arthritis

How does it work?

Nabumetone helps to reduce inflammation and to reduce pain. Nabumetone 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 Nabumetone helps to improve movement.
Nabumetone can take a few weeks to help improve inflammation but can start to relieve pain after the first few doses.

How is it used?

The usual dose of nabumetone is 1 g once a day taken preferably at bedtime with or just after food. The dose may be increased by 500 mg – 1 g a day depending on your symptoms.

What are the side effects?

The most common side effects reported are

• Dry mouth
• Faecal occult blood
• Diarrhoea
• Dyspepsia
• Nausea
• Constipation
• Abdominal pain
• Rash

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Nabumetone is known commercially as Relifex and is marketed in the UK by Meda Pharmaceuticals Ltd

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.

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Napratec is marketed in the UK by Pfizer Ltd.

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

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

Orudis capsules and suppositories contain the active ingredient ketoprofen, which is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID) and is used to treat pain caused by rheumatoid arthritis, osteoarthrosis, and ankylosing spondylitis.

How does it work?

Ketoprofen 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.

Ketoprofen 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.

Who can get it?

Available on prescription for adults.

How is it used?

The recommended dose in adults is 50—100 mg twice daily.
Orudis capsules should be taken with or after food to help avoid irritating the stomach.

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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Ketoprofen is known commercially as Orudis and is marketed in the UK by Sanofi Aventis

Oruvail controlled release capsules and Oruvail injection contain the active ingredient ketoprofen, which is a type of medicine called a non-steroidal anti-inflammatory drug (NSAID) and is used to treat pain caused by rheumatoid arthritis, osteoarthrosis, and ankylosing spondylitis.

How does it work?

Ketoprofen 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.
Ketoprofen 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.
Oruvail injection may be given for the initial relief of acute musculoskeletal pain, but you will be switched onto oral treatment as soon as possible, preferably within three days. The injection is given into the muscle of the buttock.

Oruvail capsules are controlled release capsules. They 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 controlled release action. Oruvail capsules should preferably be taken with food to help avoid irritating the stomach.

Who can get it?

Available on prescription for adults.

How is it used?

The usual adult dose is 1 to 2ml by injection into the muscle. This maybe repeated every 4 hours up to a maximum of 4ml in 24 hours. Treatment by injection is not normally continued for longer than 3 days. Elderly patients will normally be given the lowest effective dose.

Treatment by injection will usually be followed by a course of Oruvail capsules taken by mouth

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.

•Wheezing or tightness of the chest
•Faintness

• Skin rash
• Sensitivity to sunlight
• Swollen ankles
• Bad stomach pains
• Vomiting blood or dark coffee coloured granules
• Passing dark tarry bowel motions
• Bruising on your body
• Yellowing of the skin, aching limbs
• Reduced urine levels, low pack pain

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Ketoprofen is known commercially as Oruvail and is marketed in the UK by Sanofi Aventis

Pennsaid belongs to the group of medicines known as non-steroidal anti-inflammatory drugs (NSAIDs) and is made up from the active ingredient of Diclofenac. It is used for the relief of pain associated with osteoarthritis of superficial joints.

How does it work?

Diclofenac 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. Diclofenac blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.

When diclofenac is applied to the skin (topical application) it is absorbed through the skin into the underlying tissues, where it reduces pain and inflammation in the local area.

Pennsaid solution is used to relieve pain associated with osteoarthritis in superficial joints, such as the wrist or knee. There is no data on the use of Pennsaid for large, deep joints covered by layers of muscle or other soft tissues, such as the hip or spine.

Who can get it?

Available on prescription for those over the age of 18.

How is it used?

Apply 20—40 drops, depending on size of joint, in stages without rubbing in, repeat four times daily. The skin over the painful joint should be washed and dried before applying 20 – 40 drops of the solution. It should then be applied to the skin and spread evenly over the joint. The diclofenac will be absorbed into the underlying tissues of the joint where it will relieve pain.

What are the side effects?

Dry skin at application site, rash, possible systemic side effects if applied to large areas for prolonged periods. This medicine may cause dizziness and so may affect your ability to drive or operate machinery safely.
Pennsaid solution should not be taken by mouth. It is for application to the skin only.
Do not apply the solution to broken, damaged or infected skin. Do not apply to areas of skin that have been affected by skin diseases such as psoriasis, unless advised by your doctor. You should not cover the treated area with dressings.
Wash your hands after applying the solution, unless the hands are the area being treated.
Avoid contact of this medicine with the eyes and mucous membranes, such as the inside of the nose or mouth.
When diclofenac is applied to the skin it is absorbed into the bloodstream to a far lesser degree than diclofenac taken by mouth. This means it is much less likely to cause side effects on the gut than oral diclofenac. However, it is important that people with a history of disorders affecting the stomach or intestines are closely monitored by a doctor while using this medicine, particularly if elderly. Consult your doctor immediately if you experience side effects such as stomach pain, indigestion, heartburn or signs of bleeding in the stomach or intestines, e.g. blood in the stools, while using this medicine.
As it decreases pain and inflammation this medicine may mask the signs and symptoms of skin infections in the area that you apply it to. This may make you think mistakenly that an infection is getting better when it isn't, or that an infection is less serious than it is. For this reason you should tell your doctor if you get a skin infection in the area that you are using this medicine.
This medicine is not recommended for use in children

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Pennsaid is marketed in the UK by Dimethaid International.

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

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

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

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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). Vimovo is used for the treatment of acute osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis.

How does it work?

Naproxen belongs to a group of medicines called "Non-Steroidal Anti-Inflammatory Drugs" (NSAIDs). It reduces pain and inflammation. Esomeprazole belongs to a group of medicines called "proton pump inhibitors". It reduces the amount of acid in your stomach. Esomeprazole helps to reduce the risk of ulcers and stomach problems developing in patients who need to take NSAIDs.

Who can get it?

Available on prescription for adults.

How is it used?

Taking this medicineSwallow your tablets whole with a drink of water. Do not chew, split or crush the tablets. It is important that you take your tablets whole for your medicine to work properly.
Take your tablets at least 30 minutes before you have a meal.
If you are taking this medicine for a long time, your doctor will want to monitor you (particularly if you are taking it for more than a year).
How much to takeTake one tablet twice a day for as long as your doctor has told you.
Vimovo is only available in 500 mg/20 mg. If your doctor thinks this dose is not suitable for you they may prescribe another treatment.
If you take more Vimovo than you shouldIf you take more Vimovo than you should, talk to your doctor or pharmacist straight away.
Symptoms of an overdose may include dizziness, drowsiness, upper abdominal pain and or discomfort, heartburn, nausea, confusion, vomiting, bleeding of the stomach or intestines, loss of consciousness, severe swelling of the face, allergic reactions and uncontrolled movements of the body.
If you forget to take VimovoIf you forget to take a dose, take it as soon as you remember it. However, if it is almost time for your next dose, skip the missed dose.
Do not take a double dose (two doses at the same time) to make up for a forgotten dose.

What are the side effects?

Like all medicines, Vimovo can cause side effects, although not everybody gets them.
The following side effects may happen with this medicine.

• Headache.
• Feeling tired.
• Feeling thirsty.
• Feeling depressed.
• Feeling breathless.
• Increased sweating.
• Itchy skin and skin rashes.
• Spinning feeling (vertigo).
• Red or purple marks, bruising or spots on your skin.
• Feeling sick (nausea) or being sick (vomiting).
• A fluttering feeling in your heart (palpitations).
• Disturbed sleep or trouble sleeping (insomnia).
• Hearing problems such as ringing in your ears.
• Dizziness, feeling drowsy or feeling light-headed.
• Swelling of your hands, feet and ankles (oedema).
• An inflammation inside the mouth, a sore mouth or mouth ulcers.
• Eyesight problems such as blurred vision, conjunctivitis or eye pain.
• Diarrhoea, stomach pain, heartburn, indigestion, constipation, burping or wind (flatulence).

Stop taking Vimovo and see a doctor immediately if you notice any of the following serious side effects - you may need urgent medical treatment:

• Sudden wheezing, swelling of your lips, tongue and throat or body, rash, fainting or difficulties in swallowing (severe allergic reaction).
• Reddening of your skin with blisters or peeling. There may also be severe blisters and bleeding in the lips, eyes, mouth, nose and genitals.
• Yellowing of the skin or the whites of your eyes, having dark urine and tiredness which can be symptoms of liver problems.
• Medicines such as Vimovo may be associated with a small increased risk of heart attack (myocardial infarction) or stroke. Signs include chest pain spreading to your neck and shoulders and down your left arm, confusion or muscle weakness or numbness which may only be on one side of your body.
• You pass black sticky bowel motions (stools) or have bloody diarrhoea.
• You vomit any blood or dark particles that look like coffee grounds.

Vimovo may in rare cases affect the white blood cells leading to immune deficiency.

If you have an infection with symptoms such as fever with a severely reduced general condition or fever with symptoms of a local infection such as pain in the neck, throat or mouth or difficulties in urinating, you must consult your doctor as soon as possible so that a lack of white blood cells (agranulocytosis) can be ruled out by a blood test. It is important for you to give information about your medication at this time.

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Vimovo is marketed in the UK by Astra Zeneca

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 caused by Musculo-skeletal disorders, sprains, strains, back pain, rheumatoid arthritis, osteoarthritis and ankylosing spondylitis.

How does it work?

Diclofenac 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. Diclofenac blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.

Diclofenac is used to relieve pain and inflammation in a wide range of musculoskeletal conditions, including various forms of arthritis, gout, sprains, fractures, dislocations, back pain, tendinitis and frozen shoulder. It is also used to relieve pain and inflammation following dental, orthopaedic (bone) and other minor surgery.

Volsaid retard tablets are sustained-release tablets. They are designed to release the diclofenac slowly and continuously over a few hours. This provides prolonged pain relief, so these tablets are usually taken once or twice a day. The tablets must be swallowed whole to avoid damaging the sustained-release action.

Volsaid retard tablets should preferably be taken with food to help avoid irritating the stomach.

Who can get it?

Available on prescription for those over the age of 18.

How is it used?

75mg tablet; once or twice daily with or after food.
100mg tablet; once daily with or after food.

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.

• Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain
• Indigestion (dyspepsia)
• Excess gas in the stomach and intestines (flatulence)
• Loss of appetite
• Headache
• Dizziness
• Balance disorders involving the inner ear (vertigo)
• Skin rashes
• Ulceration of the stomach or intestine
• Bleeding from the stomach or intestine
• Allergic reactions such as skin rashes, swelling of the lips, tongue and throat (angioedema) or narrowing of the airways (bronchospasm)
• Drowsiness
• Fluid retention (oedema)
• Kidney, liver or blood disorders

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Volsaid Retard is marketed in the UK by Chiesi Ltd

Voltarol contains 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.

How does it work?

Diclofenac 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. Diclofenac blocks the production of these prostaglandins and is therefore effective at reducing inflammation and pain.
Diclofenac is used to relieve pain and inflammation in a wide range of musculoskeletal conditions, including various forms of arthritis, gout, sprains, fractures, dislocations, back pain, tendonitis and frozen shoulder. It is also used to relieve pain and inflammation following dental, orthopaedic (bone) and other minor surgery.
Voltarol e/c tablets have a special 'enteric coating' that is designed to prevent the absorption of the diclofenac in the stomach, and thus reduce the risk of stomach irritation. The diclofenac is absorbed when the tablet reaches the intestine. The tablets should be swallowed whole to avoid damaging this coating.
Voltarol dispersible tablets are dissolved in water before taking. The diclofenac solution is rapidly absorbed from the gut, so this type of Voltarol tablet provides pain relief more quickly than the other types of tablet. However, the solution is more likely to irritate the stomach lining, because it doesn't have the advantage of the protective enteric-coat. The dispersible tablets are therefore most suitable for short-term use. They shouldn't be used for longer than three months.
Voltarol SR tablets and Voltarol Retard tablets are sustained-release tablets. They contain higher doses of diclofenac and are designed to release this slowly and continuously over a few hours. This provides more prolonged pain relief, so these tablets are usually taken once a day. These tablets must also be swallowed whole to avoid damaging the sustained-release action.

Who can get it?

This medicine is available on prescription.

How is it used?

All types of Voltarol tablets should preferably be taken with food to help avoid irritating the stomach.

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.

• Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain
• Indigestion (dyspepsia)
• Excess gas in the stomach and intestines (flatulence)
• Loss of appetite
• Headache
• Dizziness
• Balance disorders involving the inner ear (vertigo)
• Skin rashes
• Ulceration of the stomach or intestine
• Bleeding from the stomach or intestine
• Allergic reactions such as skin rashes, swelling of the lips, tongue and throat (angioedema) or narrowing of the airways (bronchospasm)
• Drowsiness
• Fluid retention (oedema)
• Kidney, liver or blood disorders

Diclofenac Cardiac Warning

Recent cardiovascular safety concerns have led the MHRA to issue new prescribing advice for systemic forumlations of diclofenac.

The Agency cited a recently published meta-analysis that provided further evidence of an increased risk of arterial thrombosis with diclofenac, similar to that observed with COX-2 inhibitors.

The use of diclofenac is now contraindicated in patients with ischaemic heart disease, peripheral arterial disease, cerebrovascular disease or  congestive heart failure.

Patients with any of these conditions who are currently receiving diclofenac should be switched to an alternative treatment at their next appointment.

In addition, caution should be used when prescribing diclofenac in patients with significant risk factors for cardiovascular events, such as hypertension, hyperlipidaemia, diabetes mellitus and smoking.

These new contraindications and warnings apply to systemic formulations of diclofenac (tablets, capsules, suppositories and injections) but not topical products (creams and gels).

Reference: Mims August 2013 Product Update

You can report adverse drug reactions to the MHRA via the Yellow Card scheme.

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Voltarol is marketed in the UK by Novartis Pharmaceuticals UK Ltd