Nonsteroidal anti-inflammatory drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a widely used group of medications that help reduce pain, inflammation, and fever. They are commonly used for short-term pain relief and for managing long-term inflammatory conditions. NSAIDs are available in both over-the-counter and prescription forms and are a mainstay of treatment in primary care, rheumatology, and other areas of healthcare.

People often reach for NSAIDs such as ibuprofen or naproxen to treat headaches, muscle aches, or joint pain. At higher prescription doses, NSAIDs are used to manage chronic conditions like osteoarthritis and rheumatoid arthritis. While these medications are effective and familiar to many people, they can carry risks, especially with high doses or long-term use. Understanding how NSAIDs work and how to use them safely is an important part of making informed healthcare decisions.

Nonsteroidal anti-inflammatory drugs, commonly called NSAIDs, are medications that reduce inflammation, relieve pain, and lower fever. Unlike corticosteroids, NSAIDs do not contain steroids, which is where the term nonsteroidal comes from. They work throughout the body and are used for a wide range of conditions involving pain and swelling.

NSAIDs include both over-the-counter NSAIDs and prescription-strength options. Common over-the-counter choices include ibuprofen and naproxen, often sold under brand names like Advil, Motrin, and Aleve. Prescription NSAIDs include medications such as diclofenac, indomethacin, nabumetone, ketorolac, and celecoxib.

NSAIDs are frequently recommended by healthcare professionals because they provide effective pain relief and reduce inflammation without the need for stronger pain relievers like opioids in many cases.

NSAIDs work by blocking enzymes in the body called cyclooxygenase, often shortened to COX enzymes. There are two main types: COX-1 and COX-2. These enzymes help the body make prostaglandins, which are substances involved in inflammation, pain signaling, fever, and protection of the stomach lining.

By inhibiting cyclooxygenase enzymes, NSAIDs lower prostaglandin levels. This leads to reduced inflammation and pain relief. COX-2 inhibitors, such as celecoxib, are designed to focus more on the enzyme linked to inflammation while sparing COX-1, which helps protect the gastrointestinal tract.

However, blocking prostaglandins also explains many side effects of NSAIDs. Prostaglandins help maintain kidney function, protect the stomach lining, and support blood flow. When these protective effects are reduced, the risk of stomach upset, stomach ulcers, kidney disease, and cardiovascular problems can increase.

There are several types of NSAIDs, including nonselective NSAIDs and COX-2 inhibitors.

Common over-the-counter NSAIDs:

• Ibuprofen (Advil, Motrin)
• Naproxen (Aleve)

Prescription NSAIDs:

• Diclofenac
• Indomethacin
• Ketorolac
• Nabumetone
• Mefenamic acid

COX-2 inhibitors:

• Celecoxib (Celebrex)

Other formulations:

• Suppositories
• Topical NSAIDs
• Injectable forms

Low-dose aspirin is sometimes grouped with NSAIDs, but it is often used for heart disease prevention rather than pain relief. Paracetamol is often confused with NSAIDs, but it is not considered a nonsteroidal anti-inflammatory drug because it does not significantly reduce inflammation.

NSAIDs are used to treat many conditions that involve pain and inflammation. They are commonly taken for short-term pain relief from headaches, muscle strains, dental pain, and menstrual cramps. Over-the-counter NSAIDs are often the first option for mild to moderate pain.

Prescription NSAIDs are frequently used for chronic inflammatory conditions such as osteoarthritis, rheumatoid arthritis, and other rheumatology-related diseases. They help reduce joint pain, stiffness, and swelling, improving mobility and daily function.

NSAIDs may also be used to treat conditions like gout, ulcerative colitis flare-related pain, and post-surgical pain. In some cases, they are used to lower fever or manage pain associated with injuries. A healthcare professional will determine the appropriate type and dose based on the condition being treated and the patient’s risk factors.

Like all medications, NSAIDs can cause side effects. Many people tolerate them well when used at low doses for a short time, but the risk of side effects increases with higher doses and longer use of NSAIDs.

Common side effects include:

• Stomach upset or indigestion
• Heartburn
• Nausea
• Abdominal pain
• Fluid retention

More serious side effects of NSAIDs can include:

• Stomach ulcers or bleeding in the gastrointestinal tract
• Kidney disease or reduced kidney function
• High blood pressure or worsening hypertension
• Increased risk of heart attack or heart failure
• Blood clots
• Allergic reaction, such as rash or swelling
• Liver enzyme changes

Certain NSAIDs, including COX-2 inhibitors, may carry a higher risk of heart problems in some people. Older adults, people with heart disease, kidney disease, or a history of stomach ulcers are considered high risk and require careful monitoring.

These are not all of the possible side effects of Nonsteroidal anti-inflammatory drugs (NSAIDs). You should always seek medical advice from your healthcare provider for any questions or concerns about your medical condition or treatment. Read all patient information, medication guides, or drug information sheets that come with this medication. You can also report adverse effects to the Food and Drug Administration at www.fda.gov/medwatch or 1-800-FDA-1088.

NSAIDs are generally safe when used as directed and for short periods. However, safety depends on the individual, the dose, and how long the medication is used. Long-term or high-dose NSAID use increases the risk of side effects, especially involving the stomach, heart, and kidneys.

Healthcare professionals often recommend using the lowest effective dose for the shortest possible time. Regular follow-up and blood tests may be needed for people who take NSAIDs long term, especially those with existing medical conditions.

Warnings

Before starting Nonsteroidal anti-inflammatory drugs (NSAIDs), it is crucial to discuss any existing health conditions with your healthcare provider. You should be sure that your healthcare provider is aware of all your medical conditions, including if you have:

• Heart disease or heart failure
• High blood pressure
• Kidney disease or reduced kidney function
• A history of stomach ulcers or gastrointestinal bleeding
• Ulcerative colitis or other gastrointestinal conditions
• Asthma or previous allergic reaction to NSAIDs

People at higher risk may need alternative pain relievers or additional protective medications.

Boxed Warning

• Some prescription NSAIDs carry a boxed warning due to an increased risk of serious cardiovascular events, such as heart attack and stroke, as well as serious gastrointestinal bleeding. This risk may occur early in treatment and increases with higher doses and longer use.

Contraindications

• NSAIDs should not be used in people with known hypersensitivity to these drugs, those with active gastrointestinal bleeding, or certain advanced kidney conditions. They are also generally avoided before and after certain types of heart surgery. A healthcare professional will determine if NSAIDs are appropriate.

Drug interactions

When Nonsteroidal anti-inflammatory drugs (NSAIDs) are taken with other prescription drugs, over-the-counter medications, vitamins, and supplements, they may change how they work or increase the frequency or severity of side effects. Make sure that you tell your healthcare professional about anything that you are taking to avoid any negative drug interactions, including:

• Warfarin or other blood thinners
• Corticosteroids
• Low-dose aspirin
• Certain blood pressure medications
• Diuretics
• Other NSAIDs

Drug interactions can increase the risk of bleeding, kidney problems, or reduced effectiveness of treatments.