Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs are a large class of medications used to relieve pain. Examples of common pain-causing conditions that may benefit from using NSAIDs include, but are not limited to, endometriosis, osteoarthritis, psoriatic arthritis, rheumatoid arthritis, migraine, menstrual pain (dysmenorrhea), musculoskeletal sprains and strains, tendonitis, and dental-related issues. Additionally, NSAIDs are often used as a first-line treatment for generalized pain, headaches, and inflammation. NSAIDs are also used as fever-reducers. Some NSAIDs are available over-the-counter, such as aspirin, ibuprofen (Motrin, Advil), and naproxen (Aleve). Other NSAIDs, as well as higher dosages of over-the-counter NSAIDs, may be available by prescription only.

Although NSAIDs can be used to treat pain long-term, there are several risks that can accompany them. Some of these include, but are not limited to, gastrointestinal bleeding, an increased risk of developing a heart attack or stroke (except in the case of aspirin which decreases this risk), skin issues such as bruising, bleeding, or rash, and allergic reactions.1,2

Ingredients in NSAIDs

The active ingredient in an NSAID medication will vary based on which drug an individual is using. Some common active ingredients are acetylsalicylic acid (aspirin), ibuprofen, naproxen, and celecoxib (Celebrex).1,2 The active ingredient in the NSAID can be found on the bottle of an over-the-counter medication, or in the prescribing information for a prescribed NSAID. Your provider or pharmacist can also tell you what the active ingredient in your NSAID is.

How they work

Although the active ingredient in each NSAID may be different, they all function in a similar manner. In order to relieve pain, NSAIDs inhibit, or block, several enzymes that are involved in the production of prostaglandins. Prostaglandins play a role in the inflammatory and pain response pathways in the body. By reducing or blocking the formation of prostaglandin, NSAIDs are able to reduce inflammation and pain.

Enzymes are important proteins in the body that help it carry out necessary functions. The main enzymes that NSAIDs inhibit are cyclooxygenase (COX) enzymes, which can be further broken down into COX-1 and COX-2 categories. Non-specific NSAIDs, like ibuprofen or naproxen, will block both of these, while newer NSAIDs, called COX-2 inhibitors, only block COX-2 enzymes. It has been theorized that this mechanism may help prevent some of the adverse gastrointestinal symptoms that can accompany other NSAIDs. The only COX-2 inhibitor on the market right now is Celebrex. COX-2 inhibitors should not be taken with other NSAIDs.1,2

Possible side effects

Many clinical trials have evaluated the safety and efficacy of NSAIDs. Some of the most common side effects experienced while taking NSAIDs include, but are not limited to:3

These are not all the possible side effects of NSAIDs. Talk to your doctor about what to expect or if you experience any changes that concern you during treatment with NSAIDs.

Other risks

NSAIDs can lead to an increased risk of developing cardiovascular complications such as heart attack and stroke. They can also lead to an increased risk in gastrointestinal bleeding. The risk of these complications increases with:

  • Age
  • Long-term usage
  • History of smoking
  • Alcohol usage
  • Previous medical conditions including past cardiovascular-related issues
  • Concurrent use with other NSAID medications, corticosteroids, or anti-coagulant medications

If you notice signs of a cardiovascular event occurring, including chest pain, trouble breathing, slurred speech, swelling of the throat or face, or weakness in one part or side of your body, seek medical attention immediately. NSAIDs should not be taken immediately before or after a coronary artery bypass graft surgery, a surgical procedure on the heart.

Other rare but serious side effects that can accompany NSAIDs include, but are not limited to, the following:

  • Impaired kidney function
  • Anemia (low red blood cell count)
  • Impaired liver function
  • Skin reactions or increased sun sensitivity
  • Allergic reactions

Before taking NSAID medications, tell your healthcare provider:

  • About any other medications, vitamins, or supplements you are taking
  • About any past medical conditions or symptoms you have experienced
  • About any recent medical procedures
  • If you are pregnant or planning to become pregnant
  • If you are breast feeding

This is not an exhaustive list of all serious side effects and signs to watch for while taking NSAID medications. Talk with your doctor or healthcare provider about your individual situation.1-3

Dosing information

The dosing information for NSAIDs can vary greatly based on the medication taken. It is often advised to take an NSAID with food to decrease gastrointestinal upset and to avoid alcohol while taking NSAIDs. Typically, if an NSAID is available both over-the-counter and by prescription, the over-the-counter dosage will be smaller. The risk of adverse side effects developing increases with the dosage and amount of time an individual is taking an NSAID. Because of this, your provider may recommend that you only take an NSAID for a short period of time, or at a specific dose amount. It is important to follow these instructions to decrease your risk of serious side-effects as much as possible. Additionally, if needed, they may recommend other pain relief options intermittently to prevent adverse effects. If you are taking an over-the-counter NSAID on your own for ten or more days, contact your healthcare provider as soon as possible.1

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Written by: Casey Hribar | Last reviewed: February 2021