Aspirin and Other Non-steroidal Anti-inflammatory Drugs (NSAIDs)
Summary
Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and celecoxib (Celebrex) are used to reduce inflammation and pain. Compelling research is emerging that some NSAIDs may improve survival, make some cancer treatments more effective and reduce the risk of cancer.
NSAIDs are very effective at treating pain caused by inflammation. Limited evidence shows they also address other common side effects and symptoms that many people with cancer experience.
Safety is a concern, especially with long-term use. We strongly recommend medical supervision with use.
We rate NSAIDs overall:
Evidence of Effectiveness
Treating Cancer 
- Good evidence of improved survival in colorectal cancer, but likely only in specific situations, plus reduced metastasis, mostly in observational studies
- Good evidence of improved response to first-line treatment in randomized trials, but weak evidence of improved survival and fewer metastases with lung cancer
- Good evidence of slightly to considerably improved survival in bladder, head and neck, ovarian and prostate cancers with aspirin use in observational studies
- Good evidence of improved survival in stomach cancer in a randomized trial, but only among those positive for COX-2 expression
- Slightly improved survival in breast cancer, mostly when used with surgery, plus reduced metastasis, mostly in observational studies
- Very limited evidence of improved response in pancreatic cancer
Optimizing Your Body Terrain 
Inflammation and insulin resistance support cancer growth. See Body Terrain and the Tumor Microenvironment.
- Substantial evidence of anti-inflammatory effects or effectiveness
- Limited evidence of altered glucose metabolism
Managing Side Effects and Promoting Wellness
- Good clinical evidence of effectiveness reducing pain in multiple studies and meta-analyses of randomized trials
- Good evidence of improved appetite, fatigue in randomized trials
- Limited evidence of improved quality of life
- Limited evidence of improved body weight and reduced wasting (cachexia) in several cancer types, especially with non-aspirin NSAIDs
Reducing Cancer Risk
- Benefit vs risk of use varies considerably between aspirin (moderate benefit with lower risk of serious side effects) and non-aspirin NSAIDs (moderate benefit with higher risk of serious side effects).
- Benefit varies considerably by cancer type:
- Good evidence of reduced cancer risk with colorectal cancer, and less so with prostate cancer
- Limited evidence of reduced cancer risk with breast and liver cancers
- No evidence of reduced risk with bladder, esophageal, lung, pancreatic, stomach or uterine cancers with use by people aged 65 or over
Use by Integrative Oncology Experts 
- See Integrative Programs, Protocols and Medical Systems below
Safety
- NSAIDs can have serious, even life-threatening side effects. Some NSAIDs have more frequent or more serious side effects than others. We strongly enourage medical supervision with use.
- Serious side effects include bleeding, cardiovascular problems, ulcers and kidney damage.
- See Cautions below for more information about cautions with each type of NSAID.
Affordability and Ease of Access 
- Aspirin, ibuprofen (Advil, Motrin) and naproxen (Aleve and other brands) are widely available in drugstores and many grocery stores.
- Of the NSAIDs reviewed on this page, these require a prescription in the US:
- Celecoxib (Celebrex)
- Diclofenac (Cambia and other brands)
- Ibuprofen (at higher doses)
- Indomethacin (Indocin, Tivorbex)
- Ketorolac (Acuvail, Acular LS, Acular, and ReadySharp)
- Sulindac (Clinoril)
- Prices are generally low to moderate, and costs for prescription drugs may be covered by insurance.
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Authors
Nancy Hepp, MS, BCCT Project ManagerDetails and Evidence
COX InhibitorsYou’ll see throughout this page mentions of COX-2 inhibitors. Cyclooxygenase-2 (COX-2) is an enzyme responsible for inflammation and pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) that directly target COX-2:1 More COX-2 selective: meloxicam, nimesulide
NSAIDs that are non-selective COX inhibitors:
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Because the safety profiles and cautions can be very different between aspirin and other NSAIDs, we list the evidence separately whenever possible, even when the impacts with cancer are similar. Some studies lump the effects of aspirin and other NSAIDs together, and so we can evaluate only what researchers report. For many types of cancer and side effects, you may see up to three sections:
- All NSAIDs combined
- Aspirin
- Non-aspirin NSAIDs
We encourage our readers to evaluate the safety and cautions regarding each type of NSAID along with the evidence of effectiveness and potential benefit in your type of cancer or symptoms. We also strongly encourage you to seek professional medical supervision in using any NSAIDs, even those available without a prescription.
Non-aspirin Nonsteroidal Anti-inflammatory Drugs (NSAIDs) Reviewed on This Page
Further NSAIDs are listed by the US Food and Drug Administration: FDA strengthens warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or strokes
| Generic name | Brand name(s) |
|---|---|
|
Celecoxib |
Celebrex |
|
Diclofenac |
Cambia, Cataflam, Dyloject, Flector, Pennsaid, Solaraze, Voltaren, Voltaren-XR, Zipsor, Zorvolex, Arthrotec (combination with misoprostol) |
|
Ibuprofen* |
Advil, Advil Dual Action (with acetaminophen), Caldolor, Children’s Advil, Children’s Elixsure IB, Children’s Motrin, Ibu-Tab, Ibuprohm, Motrin IB, Motrin Migraine Pain, Profen, Tab-Profen, Duexis (combination with famotidine), Reprexain (combination with hydrocodone), Vicoprofen (combination with hydrocodone) |
|
Indomethacin |
Indocin, Tivorbex |
|
Ketorolac |
Sprix |
|
Naproxen* |
Aleve, Anaprox, Anaprox DS, EC-Naprosyn, Naprelan, Naprosyn, Treximet (combination with sumatriptan), Vimovo (combination with esomeprazole) |
|
Sulindac |
Clinoril |
*Many over-the-counter (OTC) products contain this drug.
Clinical Practice Guidelines
Aspirin
US Preventive Services Task Force (USPSTF) issued a grade B recommendation for the use of low-dose aspirin (75 to 100 mg/day) for the primary prevention of cardiovascular disease and colorectal cancer in adults 50 to 59 years of age who have a 10 percent or greater 10-year cardiovascular disease risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years and are willing to take low-dose aspirin daily for at least 10 years. The USPSTF also recommended that the decision to use low-dose aspirin for preventing cardiovascular disease and colorectal cancer in adults age 60 to 69 years who have a 10 percent or greater 10-year cardiovascular disease risk should be an individual one. (grade C)2
Other NSAIDs
USPSTF acknowledges benefits in certain high-risk groups but is against general use of non-aspirin NSAIDs for prevention due to the risk of serious cardiovascular and gastrointestinal side effects.3
Treating the Cancer
Clinical Evidence
NSAID use shows anticancer action and improves survival in some cancer types, as detailed below. The impact varies substantially by the type of NSAID used, the cancer type and stage, and characteristics of the people in the studies, such as body weight, presence of diabetes, or other therapies used in tandem.
Adrenal Cancer/Neuroblastoma
Non-aspirin NSAIDs
Diclofenac
- Anticancer effects, including positive responses in high-risk refractory or metastatic neuroblastoma in case studies4
Bladder Cancer
Aspirin
- Increased survival with use at least three times a week by people with bladder cancer in a large observational study5
Breast Cancer
All NSAIDs Combined
- Increased survival with breast cancer in observational studies6
- Reduced size of the primary tumor, improved lymph node status and fewer involved axillary nodes (lymph nodes near the armpit) in observational studies7
- Reduced metastasis with use both before and after cancer diagnosis in a large meta-analysis of mainly observational studies8
Aspirin
Conflicting findings to date indicate that any benefit in breast cancer may be small:
- Weak trend toward improved survival with low-dose aspirin in a review of observational studies9
- Increased survival with use at least three times a week in some large observational studies,10 but no improved survival in another11
- Reduced metastasis in a meta-analysis of observational studies12
- Possible synergistic effects of aspirin with exemestane in treating estrogen-responsive breast cancer13
Non-aspirin NSAIDs
COX-2 inhibitors including celecoxib/Celebrex
- Improved treatment effects in combination with an aromatase inhibitor, but only in tamoxifen-resistant women14
- Possible synergistic effects of celecoxib with exemestane and tamoxifen in treating estrogen-responsive breast cancer,15 including longer time to progression with exemestane with no additional adverse effects compared to exemestane alone16
Diclofenac
- Improved disease-free and overall survival when used at the time of conservative breast cancer surgery in an observational study17
Ketorolac
- Improved disease-free survival in the first few years after surgery when used around the time of surgery in observational studies18
Colorectal Cancer
All NSAIDs Combined
- Inhibited gene mutations that are linked to uncontrolled proliferation of cells, and also induced cell death (apoptosis), improving survival19
- Improved survival for people with type 2 diabetes with stage 2 and 3 colorectal cancer treated with both aspirin and metformin in an observational trial20
- Reduced resistance to therapies:21
- Chemotherapy: some studies have shown survival benefit, but many have not shown improved patient outcomes.
- Molecular targeted therapy combining NSAIDs with targeted therapy (cetuximab): improved overall survival in colorectal cancer in people with KRAS wild-type mutations but not KRAS-mutated cancers.
Aspirin
- Improved survival in general in observational studies,22 but considerable variation in individual study findings depending on study specifics:
- Improved overall survival when used after diagnosis but not before diagnosis, and only in patients positive for COX-2 expression (which influences tumor invasiveness and inflammatory responses) and mutated PIK3CA tumors23
- Improved colorectal cancer-specific survival and lower odds of diagnosis with distant metastases with long-term regular use of aspirin (more than 15 times per month) before diagnosis; beginning regular aspirin use only after diagnosis improved survival compared with no aspirin use24
- Improved survival in those with wild-type BRAF tumors but not mutated BRAF tumors25 or with PI3K mutation26
- Improved all-cause and cancer-related survival at varying doses, irrespective of body mass index27
- Improved survival for type II diabetes patients with stage 2 and 3 colorectal cancer treated with both aspirin and metformin28
- Improved survival in tumors with low PD-LI expression (which inhibits immune action against tumors) with aspirin use with immunotherapy29
- Improved five-year progression-free survival and a lower risk of developing metastasis30
- Inhibited gene mutations which can contribute to uncontrolled proliferation of cells and also induced cell death (apoptosis), improving survival31
- Induced cell death (apoptosis), improving survival and reducing recurrence in metastatic colorectal cancer32
- Slowed polyp progression in patients with hereditary nonpolyposis colorectal cancer33
- Decreased tumor size (tumor downstaging) with use during chemoradiation before surgery for rectal cancer in an observational study34
- No improvements in toxicity or response rate (pathological complete response rate) in rectal cancer patients undergoing neo-adjuvant long-course radiation therapy in an observational study35
Non-aspirin NSAIDs
- No improved survival:
- No improvement in disease-free survival or overall survival among people with stage 3 colon cancer with three years of celecoxib (Celebrex) added to standard adjuvant fluorouracil, leucovorin, and oxaliplatin (FOLFOX) in a large randomized trial36
- Improved survival:
Head and Neck Cancer
All NSAIDs Combined
- Considerably improved cancer-specific survival when used six months or more among people with head and neck cancer with PIK3CA mutations or amplification (PIK3CA-altered) in an observational study39
Lung Cancer
All NSAIDs combined
- Lower risk of distant metastasis with use at the beginning of surgery with non-small cell lung cancer in an observational study40
Non-aspirin NSAIDs
- Improved survival with ketorolac use during surgery in an observational study41
- Improved response to first-line treatment but mixed evidence on impacts on survival with celecoxib in advanced non-small cell lung cancer in randomized trials42
Ovarian Cancer
All NSAIDs Combined
- Improved ovarian cancer-specific and overall survival with recent use of aspirin and non-aspirin NSAIDs after diagnosis in a large observational study43
Aspirin
- Improved survival with epithelial ovarian cancer with use after diagnosis in a large observational study44
Non-aspirin NSAIDs
Pancreatic Cancer
Non-aspirin NSAIDs
- Progression-free response for 16 months after diagnosis with inoperable pancreatic cancer with long-term use of a combination product of diclofenac, cimetidine, low-dose cyclophosphamide and sulfasalazine, plus gemcitabine in a case study47
Prostate Cancer
All NSAIDs Combined
- Reduced metastasis with use both before and after cancer diagnosis in observational studies48
Aspirin
- Longer overall survival but not prostate cancer-specific survival in a large observational study49
- Increased disease-free survival in men of African-American descent in an observational study50
- Reduced metastasis with use both before and after cancer diagnosis in a large meta-analysis of observational studies51
- No benefit from use after diagnosis in an observational study52
Sarcoma
Non-aspirin NSAIDs
Diclofenac
- Anticancer effects, including positive responses in case studies in these conditions:53
- Desmoid tumours (metronomic treatment)
- Inflammatory myofibroblastic tumors
Stomach Cancer
Non-aspirin NSAIDs
Celecoxib (Celebrex)
- Improved progression-free and overall survival in people with metastatic or postoperative recurrent stomach (gastric) cancer when combined with chemotherapy, but only among those who were positive for COX-2 expression (which influences tumor invasiveness and inflammatory responses) in a randomized trial54
Lab and Animal Evidence
A sample of preclinical evidence in several types of cancer
All NSAIDS Combined
Aspirin
- Breast cancer: increased death of mutant PIK3CA breast cancer cells57
- Colorectal cancer:
- Ovarian cancer: phosphatidylcholine-associated aspirin (aspirin-PC) showed anticancer effects in cells and reduced ovarian cancer growth by 50 percent to 90 percent in animals, with no detectable gastrointestinal toxicity; the effect was enhanced in combination with bevacizumab (Avastin) or B20.60
- Pancreatic cancer: reversed or inhibited the activity of platelets promoting pancreatic cancer cell proliferation and metastasis61
Non-aspirin NSAIDs
Celecoxib (Celebrex)
- Anticancer effects from a combination dose of celecoxib and fish oil in rats62
- Anticancer effects in breast cancer, including sensitizing tumors to antitumor drugs63
- Anticancer effects in colorectal cancer,64 including increased sensitivity of colon cancer cells to radiotherapy65
- Anticancer effects in melanoma when used with rapamycin66
- Anticancer effects in ovarian cancer:67
- Improved survival in rats68
- Decreased proliferation, increased programmed cell death (apoptosis) and other anticancer effects in animal studies69
- Significantly enhanced effects of cisplatin on intrinsically resistant primary ovarian cancer cells when used in combination with sorafenib and sildenafil before chemotherapy, with more limited results for oxaliplatin and carboplatin70
- Anticancer effects in prostate cancer,71 including when used jointly with other therapies:
Diclofenac
- Antiproliferative, anti-angiogenic and other anticancer effects in these cancers:75
- Adrenal gland tumors (neuroblastoma)
- Brain cancer (glioma)
- Colorectal cancer
- Leukemia
- Liver (hepatocellular)
- Melanoma
- Ovarian
- Pancreatic
- Prostate
- Sarcoma (fibrosarcoma)
Indomethacin
- Increased sensitivity to doxorubicin in esophageal squamous cell carcinoma cells76
Noscapine
- Ovarian cancer:
- Effective against taxane-resistant ovarian cancer with minimal neurotoxicity or immunosuppression in mice77
- Inhibited proliferation of both paclitaxel-sensitive and paclitaxel-resistant human ovarian carcinoma cells78
- Increased anticancer activity of cisplatin against drug-resistant ovarian cancer cells79
- Increased cell death (apoptosis) in ovarian cancer cells80
Optimizing Your Terrain
See Body Terrain and the Tumor Microenvironment.
All NSAIDs Combined
- Anti-inflammatory81
Aspirin
- Anti-inflammatory82
Non-aspirin NSAIDs
Celecoxib
- Anti-inflammatory:
- Reduced CRP—a marker of inflammation—when combined with fish oil supplementation in patients with advanced and progressive lung cancer83
- Reduced markers of inflammation when combining celecoxib with megestrol acetate (MA), carnitine and antioxidants in women with advanced gynecological cancer, compared to MA alone84
- Suppressed systemic inflammation and led to weight gain in cachetic animals with colon or head and neck cancers85
- Affected genes and pathways involved in inflammation and malignant transformation in tumors but not normal tissues86
- Improved inflammatory response in liver cancer cells87
- Improved immune system function:
- Reduced the COX-2 inhibition on signalling proteins (chemokines)—associated with improved survival—in high-grade serous ovarian cancer90
Diclofenac
- Immune system support and effects91
- Altered glucose metabolism in cell lines of leukemia, melanoma and prostate cancer92
Ibuprofen
- Anti-inflammatory: reduced a marker of inflammation in patients with advanced metastatic gastrointestinal cancer when combined with megestrol acetate (MA)93
Managing Side Effects and Promoting Wellness
Changes in Appetite
Non-aspirin NSAIDs
Fatigue
Non-aspirin NSAIDs
Celecoxib
Pain
The main use of NSAIDs is to reduce fever and inflammation, which is often accompanied by pain97 Because NSAIDs are so effective in reducing pain from inflammation, they are some of the most commonly used medications.98 The World Health Organization includes aspirin (acetylsalicylic acid) and ibuprofen (Advil, Motrin and other brands) in their 2019 Model List of Essential Medicines.
All NSAIDS Combined
- Reduced pain intensity, relief from cancer pain (including when used with opioids) and reduced use of opioids in randomized trials99
Non-aspirin NSAIDs
Diclofenac
Indomethacin
- Reduced pain and use of additional analgetics in a randomized trial101
Quality of Life
All NSAIDs Combined
- May improve self-reported quality of life, as shown in both randomized and observational trials102
Non-aspirin NSAIDs
Ibuprofen
- Improved quality of life in patients with advanced metastatic gastrointestinal cancer when combined with megestrol acetate (MA) in a randomized trial103
Celecoxib
- Improved global quality of life when combining celecoxib with megestrol acetate (MA), carnitine and antioxidants in women with advanced gynecological cancer, compared to MA alone in a randomized trial104
- Higher overall quality of life among people with metastatic or postoperative recurrent stomach (gastric) cancer when combined with chemotherapy in a randomized trial105
Wasting (Cachexia)
For Health Professionals: Managing CachexiaOne author advises that single or multiple drugs alone are not sufficient to treat cachexia. Drugs need to be combined with dietary counseling, supplementation, symptom management, and exercise.106 Also, consider that many of the patients with cachexia usually have multiple other symptoms and are frail and often elderly. Use the lowest effective dose of NSAIDs for the shortest period of time and monitor regularly for early detection of adverse events.107 |
All NSAIDs Combined
- May improve body weight, but evidence in 2013 was not strong enough to recommend using NSAIDs for cancer cachexia outside of clinical trials108
Non-aspirin NSAIDs
Celecoxib (Celebrex)
- Improved body weight and handgrip strength with celecoxib and fish oil supplementation in patients with advanced and progressive lung cancer in a small randomized trial109
- Increased lean body mass, improved resting energy expenditure when combining celecoxib with megestrol acetate (MA), carnitine and antioxidants in women with advanced gynecological cancer in a randomized trial110
- Improved body weight and body mass in people with gastrointestinal or head and neck cancer in a small randomized trial111
- Preclinical evidence: suppressed systemic inflammation and led to weight gain in cachetic animals with colon or head and neck cancers112
Ibuprofen (Advil, Motrin and other brands)
- Improved weight in patients with advanced metastatic gastrointestinal cancer when combined with megestrol acetate (MA) in a small randomized trial113
Indomethacin
Other Side Effects and Symptoms
All NSAIDs Combined
- May improve physical performance, as concluded by a review of evidence of several small observational studies116
Aspirin
- Reduced vascular disease events, including venous thromboembolism (but not specific to people with cancer117
Non-aspirin NSAIDs
Celecoxib (Celebrex)
- No difference in the incidence of nausea of vomiting, neutropenia, loss of appetite (anorexia), peripheral neurotoxicity, diarrhea, weakness (asthenia) and low levels of platelets (thrombocytopenia) among people with metastatic or postoperative recurrent stomach (gastric) cancer when combined with chemotherapy in a randomized trial118
Reducing Risk
Clinical Evidence
Bladder Cancer
Aspirin
- No reduced risk among individuals aged 65 years or older in an observational study119
Breast Cancer
All NSAIDs Combined
- Reduced recurrence in observational studies120
- Reduced risk, especially with aspirin and COX-2 inhibitors,121 but restricted to estrogen-positive, progesterone-positive (ER/PR+) tumors in a meta-analysis analysis of both randomized and observational studies122
- Reduced risk of lymph nodes containing cancer cells (positive lymph nodes) and larger tumors in an observational study123
Aspirin
- Reduced breast cancer risk in observational studies,124 though risk may vary by cancer type and menopausal status, with decreased risk of in situ breast tumors or hormone receptor-positive tumors and reduced risk in postmenopausal women125
- No reduced risk was seen among individuals aged 65 years or older in a large observational study126
Non-aspirin NSAIDs
- Possibly reduced breast cancer risk in some observational studies127 but not all128
- Decreased risk of recurrence with ketorolac use before surgery in observational studies,129 especially among patients with high body mass index (BMI), but not with diclofenac130131
- Reduced risk of recurrence with ketorolac and ibuprofen in observational studies132
Colorectal Cancer
All NSAIDs Combined
- Reduced risk of colorectal cancer in observational studies,133 especially of distal colon cancer, at higher doses, in women and in Caucasians134
- Inhibited gene mutations linked to uncontrolled proliferation of cells, and also induced cell death (apoptosis), reducing recurrence135
Aspirin
- Recommended by the US Preventive Services Task Force for primary prevention of colorectal cancer136
- Reduced risk of colorectal cancer in both epidemiologic and randomized studies137 including in people with hereditary colorectal cancer (Lynch syndrome)138
- Reduced metastasis139
- Inhibited gene mutations that are linked to uncontrolled proliferation of cells, and also induced cell death (apoptosis), reducing recurrence140
- Reduced risk may depend on dose and may interact with height, weight and age of the individual in randomized trials;141 no reduced risk was seen among individuals aged 65 years or older in one large observational study,142 while another study found reduced risk in those over 70 only if use was initiated when younger143
- Prevented recurrence of colorectal adenomas in an observational study,144 including possibly in individuals with an increased risk of colorectal cancer in both randomized and observational studies145
- Slowed polyp progression in patients with hereditary nonpolyposis colorectal cancer146
Non-aspirin NSAIDs
- Cardiac toxicity currently limits use, as most studies conclude that risks of serious cardiovascular events outweigh the preventive benefits of long-term use147
- COX-2 inhibitors: reduced risk of adenomas and colorectal cancer148 and of recurrent colorectal adenomas and advanced adenomas when taken for two to four years, with a weak trend toward an increased risk of recurrent adenomas two years after stopping use in randomized trials149
- Sulindac: reduced number and size of colorectal adenomas in people with Lynch syndrome in reviews of epidemiologic and randomized trials150 and in people with hereditary nonpolyposis colorectal cancer;151 including when when used with difluoromethylornithine (DFMO), without a significant increase in adverse events in a randomized trial152
Esophageal Cancer
Aspirin
- No reduced risk of esophageal cancer among individuals aged 65 years or older in an observational study153
Head and Neck Cancer
Aspirin
- Lower risk of head and neck squamous cell carcinoma with regular use154
Liver Cancer
Aspirin
- Reduced risk of liver cancer in patients with chronic viral hepatitis without raising risk of gastrointestinal bleeding with low-dose use (160 mg or less) in an observational study155
Lung Cancer
Aspirin
- No reduced risk of lung cancer among individuals aged 65 years or older in an observational study156
Pancreatic Cancer
Aspirin
- No reduced risk of pancreatic cancer among individuals aged 65 years or older in an observational study157
Prostate Cancer
All NSAIDs Combined
- Reduced risk of prostate cancer, especially with NSAIDs that inhibit COX‐2 activity in an observational study158
Aspirin
- Reduced risk of prostate cancer in an observational study159
- Decreased risk of advanced stage prostate cancer in men of African-American descent in an observational study160
- Small to moderately reduced incidence of lethal cancers (metastatic or fatal) in both observational and randomized studies161
- No reduced risk among individuals aged 65 years or older in an observational study162
Non-aspirin NSAIDs
- Decreased risk of prostate cancer, particularly among men with an aggressive prostate cancer or a personal history of prostatitis, in an observational study163
- Weak trend toward reduced risk of total, low- or high-grade prostate cancer in an observational study164
- COX-2 inhibitors: reduced risk of developing prostate cancer in observational studies165
Stomach Cancer
Aspirin
- No reduced risk of stomach cancer among individuals aged 65 years or older in an observational study166
Uterine Cancer
Aspirin
- No reduced risk of uterine cancer among individuals aged 65 years or older in an observational study167
Lab and Animal Evidence
Aspirin
- Colorectal cancer: reduced cancer cell proliferation and metastasis168
Non-aspirin NSAIDs
- Colorectal cancer: reduced risk of colon cancer in mice with naproxen use169
Integrative Programs, Protocols and Medical Systems
| For more information about programs and protocols, see our Integrative Programs and Protocols page. |
- Programs and protocols
Cautions
NSAIDs can have serious, even life-threatening side effects. Some NSAIDs have more frequent or more serious side effects than others. Use them only under medical supervision.
Caution is advised for those with hypertension or risk factors for gastrointestinal bleeding. Discontinuing NSAID use in cancer patients is not advised in one review, but careful monitoring for side effects such as cardiovascular events (COX-2) or gastrointestinal bleeding is recommended.173
One study found a trend toward increased risk of cancer progression with use by elderly patients with stage 3 or 4 cancers.174
Side Effects
All NSAIDs, including Aspirin
All NSAIDs, including those available over-the-counter, can have these side effects:
- Allergic reactions, including potentially serious reactions
- Bleeding, including bleeding of the stomach or intestines or within the skull
- Drowsiness
- Excess stomach acid secretion
- Gastrointestinal upset, nausea or ulcers (risk of ulcers is increased with alcohol use)
- Heartburn
- Nausea
- Worsening asthma symptoms
Aspirin
In addition to the side effects and risks mentioned above, aspirin may also cause these symptoms and conditions:175
| Common side effects | Rare side effects |
|---|---|
|
|
Non-aspirin NSAIDs
The US Food and Drug Administration warns that ibuprofen (Advil, Motrin and other brands), naproxen (Aleve and other brands), diclofenac, celecoxib (Celebrex) and other NSAIDs increase the risk of heart attack or stroke, even after just a few weeks of use. Medical supervision is strongly advised with all NSAIDs.176
Other side effects (in addition to those listed above for all NSAIDs):177
| Common side effects | Rare side effects |
|---|---|
|
|
A randomized trial found celecoxib (Celebrex) increased the risk of hypertension of any grade during FOLFOX treatment and increased the risk of a grade 2 or higher elevation in creatinine levels after completion of FOLFOX.178
Because of these risks, many researchers investigating use of NSAIDs other than aspirin for reducing cancer risk have concluded that risks of serious cardiovascular events outweigh the cancer-preventive benefits of long-term use.179
Drug Interactions
- Celecoxib (Celebrex)180
- Increases the concentration of lithium in the blood and may increase the blood-thinning effect of warfarin (Coumadin)
- Fluconazole (Diflucan) impairs metabolism of celecoxib (Celebrex), increasing its level in the body.
Further drug interactions are listed by the National Health Service: NSAIDs.
Commentary
BCCT advisor Keith Block, MD,181 and Raymond Chang, MD,182 prescribe COX-2 inhibitors such as celecoxib (Celebrex) in a variety of cancers, including breast cancer. Dr. Block prefers to get at the root of inflammation using diet and other non-drug approaches, but in some situations he uses Celebrex to block the COX-2 enzyme, “since the inflammatory chemicals the enzyme spawns play a major role in blocking the effectiveness of chemotherapy and radiation.”183
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More Information
- National Cancer Institute: Pain Control: Support for People with Cancer
- Piazuelo E, Lanas A. NSAIDs and gastrointestinal cancer. Prostaglandins & Other Lipid Mediators. 2015;120:91–96.
- US Food and Drug Administration:
- Moss Reports podcast: Repurposed Drugs for Cancer with Raymond Chang, MD
- LifeExtension Nutritional Support: Cancer Adjuvant Therapy: Repurposing Common Drugs as Adjuvant Cancer Therapies
- Raymond Chang, MD: Beyond the Magic Bullet: The Anti-Cancer Cocktail
- Donald I. Abrams, MD, and Andrew T. Weil, MD: Integrative Oncology, 2nd Edition
- Lise Alschuler, ND, FABNO, and Karolyn Gazella: The Definitive Guide to Cancer, 3rd Edition
- Keith I. Block, MD: Life over Cancer: The Block Center Program for Integrative Cancer Treatment
- Michael Lerner: Choices In Healing: Integrating the Best of Conventional and Complementary Approaches to Cancer
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