NSAIDs, or nonsteroidal anti-inflammatory drugs, help reduce pain and inflammation. They come in different forms and dosages that can affect their overall strength.

NSAIDs are available in both over-the-counter (OTC) and prescription strengths. Though there are a variety of different NSAIDs available, two more common examples include ibuprofen and aspirin.

A doctor may recommend the use of NSAIDs to treat:

For short-term use, they are generally safe. However, certain people, such as those in their third trimester of pregnancy or people with kidney issues, should avoid their use.

Long-term use may increase the risk of adverse reactions, such as stomach bleeding and kidney issues.

This article reviews the categories of NSAIDs, lists of different NSAIDs, possible side effects, and more.

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NSAIDs come in several different forms based on their chemical structure and selectivity. They include:

  • acetylated salicylates (aspirin)
  • non-acetylated salicylates (diflunisal, salsalate)
  • anthranilic acids (meclofenamate and mefenamic acid)
  • propionic acids (naproxen and ibuprofen)
  • enolic acids (meloxicam and piroxicam)
  • acetic acids (diclofenac and indomethacin)
  • naphthylalanine (nabumetone)
  • selective COX-2 inhibitors (celecoxib, etoricoxib)

They also fit into one of two groups: non-selective and selective.

To understand these groupings, a person needs to know how NSAIDs work.

NSAIDs primarily target an isoenzyme known as cyclooxygenase (COX). The body needs COX to convert arachidonic acid into prostaglandins, thromboxanes, and prostacyclins. The absence of these chemicals in the body is likely how NSAIDs work to relieve pain, inflammation, and fever.

For example, thromboxanes help with platelet adhesion. Prostaglandins may play a role in opening up blood vessels. They also help with temperature regulation and how the body responds to mechanical injuries.

There are two types of cyclooxygenase isoenzymes: COX-1 and COX-2. They each play slightly different roles in the body:

  • COX-1 helps the body maintain platelet aggregation, gastrointestinal mucosa lining, and kidney function.
  • COX-2 helps the body with the inflammatory response due to injury or illness.

The majority of NSAIDs are non-selective. This means they target both COX-1 and COX-2 isoenzymes. This may lead to different adverse reactions as they can affect different systems in the body.

Selective, also known as COX-2 selective, only targets COX-2. Currently, in the United States, celecoxib is the only NSAID available in this group.

By selectively targeting only COX-2, celecoxib can help with inflammation without affecting other systems in the body, such as the kidneys.

NSAIDs do not neatly fit into a listing of strongest to weakest. Dosing and formulas can affect how they work, how quickly they work, and how many tablets or pills a person needs.

Prescription-only

A doctor has several options to choose from when it comes to prescription NSAIDs. Except for celecoxib, they are all non-selective forms of NSAIDs.

Though they may share similar strengths, dosing, and potential side effects, a person should follow all instructions from a doctor or pharmacist when taking the medications and not assume that if they switch medications, the dosing will be the same.

Prescription-only NSAIDs include:

  • diclofenac
  • diflunisal
  • etodolac
  • fenoprofen
  • flurbiprofen
  • indomethacin
  • ketoprofen
  • ketorolac
  • mefenamic acid
  • meloxicam
  • nabumetone
  • oxaprozin
  • piroxicam
  • sulindac

Available OTC and prescription

Some NSAIDs come in both OTC and prescription forms.

Examples of NSAIDs that come in both forms include:

A person can typically find both OTC ibuprofen and naproxen in brand name and generic forms. Many pharmacies carry a “store brand” that is generally lower cost than brand name options.

Two well-known brand-name carriers of ibuprofen include Advil and Motrin. Aleve is a well-known type of naproxen.

The typical dose for OTC ibuprofen is 400 milligrams (mg) taken every 4 to 6 hours.

Naproxen comes in several doses, including 250 mg, 375 mg, and 500 mg. A typical dosage is one to two 220 mg tablets every 8 to 12 hours.

The exact dose and how frequently a person should take these medications can vary based on the formula (quick-release or extended-release) and the underlying condition a person or doctor is trying to treat.

A person should follow a doctor or pharmacist’s instructions for when and how to take the medications. People should follow the package’s instructions when taking OTC NSAIDs and not exceed the maximum daily dose.

Available OTC

Currently, aspirin is available only in OTC form, though naproxen and ibuprofen have OTC formulas and prescription forms.

Like other forms of NSAID, aspirin comes in several different formulas and doses, such as slow-release 81 mg tablets or regular strength tablets. Regular-strength aspirin often comes in 325 mg tablets. A person typically takes 1 or 2 tablets every 4 hours.

A person should always follow the instructions on the package when taking aspirin.

Experts often warn that NSAIDs can potentially cause serious side effects. Healthcare professionals should consider several factors when recommending or prescribing NSAIDs, such as current medications a person is taking, the possibility of side effects, and underlying health conditions a person has.

Some possible side effects of NSAIDs include:

NSAIDs can negatively affect several systems in the body, including the following:

  • gastrointestinal tract
  • kidneys
  • cardiovascular system
  • liver (less common)
  • clotting effect of blood, mainly an issue for people with stomach ulcers

Certain people should avoid NSAID use, such as people with kidney disease or stomach ulcers.

A person should discuss NSAID use with a doctor if they have any concerns, particularly if they have an underlying health condition or take other medications regularly.

NSAIDs can interact negatively with other medications. Drug interactions can cause medications to work differently by increasing or reducing their effects.

Some medications NSAIDs can interact with include:

A person should talk to a doctor before taking NSAIDs if they currently take medications to treat other conditions. A doctor may be able to provide different options or recommendations for pain, fever, or swelling.

NSAIDs help control pain, inflammation, and fever. A person may use them to treat occasional aches and pains or treat health conditions, such as arthritis.

NSAIDs come in both prescription and OTC strengths. They also come in different formulas that can affect how quickly they work, how long they work, and their dosage. A person should follow all package, doctor, or pharmacist recommendations when taking the medications.