Non-steroidal Anti-inflammatory Drugs (NSAIDs)
Reviewed by: HU Medical Review Board | Last reviewed: March 2022 | Last updated: October 2022
NSAIDs, or non-steroidal anti-inflammatory drugs, are commonly used pain medications, and are also often used to treat rheumatoid arthritis (RA). NSAIDs not only can relieve pain, but they are also effective in reducing inflammation, swelling, redness, and fever.1
Available over the counter and in prescription form, common NSAIDs include:1-4
- Ibuprofen (brand names include Motrin® and Advil®)
- Naproxen (brand names include Aleve® and Naprosyn®)
- Diclofenac (brand names include Voltaren® and Cataflam®)
- Ketoprofen (brand names include Orudis® and Oruvail®)
- COX-2 inhibitors [brand names include Celebrex® (celecoxib)]
- Meloxicam (brand names include Mobic™)
Uses of NSAIDs
NSAIDs are used to relieve pain and reduce signs of inflammation, including fever, swelling, and redness. NSAIDs are commonly used for temporary conditions, such as sprains, strains, flares of back pain, headache, and painful menstrual periods. NSAIDs are also commonly used to treat chronic conditions, including forms of arthritis and lupus. While over-the-counter NSAIDs are often enough for temporary conditions like sprains or headache, doctors will often prescribe higher doses for chronic health conditions like RA. Low doses of NSAIDs reduce pain, but higher doses are often needed to reduce inflammation.1
How NSAIDs work
NSAIDs block enzymes in the body that make prostaglandins, naturally occurring fatty acids that play a role in the inflammatory and pain processes. By blocking these enzymes, NSAIDs decrease inflammation, pain, and fever. Some NSAIDs, like ibuprofen, block two of these enzymes, COX-1 and COX-2. Celebrex, a prescription NSAID, targets COX-2 and is also known as a COX-2 inhibitor. Different NSAIDs may have similar effectiveness, but some people respond better to one NSAID than another.1,2
NSAIDs start to work quickly on pain, within a few hours of taking the medicine. The anti-inflammatory effects of NSAIDs take longer to realize.1
Possible side effects
Like all medicines, NSAIDs can cause unwanted side effects. Some side effects are minor like stomach upset, other possible side effects include stomach ulcer, high blood pressure, fluid retention (causing swelling around the lower legs, feet, ankles, and hands), kidney problems, heart problems, and rashes. Long-term use of NSAIDs has been associated with heart attacks and strokes. Although side effects can occur at any time, the risk of side effects increases with higher dosages and with a longer duration of treatment. Patients should discuss the risks and benefits with their doctor, as well as any additional precautions to avoid side effects.1,2
One of the benefits of treatment with COX-2 inhibitors is reduced gastrointestinal side effects, such as ulcers and stomach upset. Still, other side effects, such as impaired kidney function, high blood pressure, and fluid retention/swelling can occur with treatment.3 These are not all the possible side effects of NSAIDs. Patients should talk to their doctor about what to expect with treatment with NSAIDs.
Although NSAIDs are very effective for relieving pain and inflammation, they are not the best choice for all people.1
Other precautions
People who have heart disease should not take an NSAID, including over-the-counter NSAIDs, without first talking to their doctor. Some NSAIDs may interfere with medicines prescribed to patients with heart disease.1
NSAIDs should not be used during pregnancy unless prescribed by a doctor. Women who are planning to become pregnant or breastfeeding should also talk to their doctor before taking NSAIDs.1
Patients with the following conditions should talk to their doctor before using NSAIDs: decreased kidney or liver function, hepatitis, ulcer, gastritis, low platelet count, Crohn’s disease, ulcerative colitis, asthma or other chronic lung disease, reflux disease, indigestion, hiatal hernia, high blood pressure, congestive heart failure, past stroke or heart attack, allergies to NSAIDs, use of blood thinners, use of corticosteroids, are 65 years of age or older, or alcohol consumption of more than seven alcoholic drinks per week or more than two a day.1
