Last Updated on May 6, 2023

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used medications worldwide. Available over-the-counter or by prescription, NSAIDs are used to treat a variety of uncomfortable conditions.

However, despite their popularity, many people are still unsure of what NSAIDs are, how they work, and the potential risks associated with their use. In this article, we will explain everything you need to know about NSAIDs, including their mechanism of action, common uses, and potential side effects.

What Are NSAIDs?

NSAIDs, or nonsteroidal anti-inflammatory drugs, are a class of medications used to treat pain, fever, and inflammation. NSAIDs have applications for both chronic inflammation and acute inflammation.

How Do NSAIDs Work?

NSAIDs work by interfering with the production of enzymes called cyclooxygenases (COX), which are responsible for the production of chemicals called prostaglandins (one of the main causes of inflammation, pain, and swelling in response to injury or infection).

To be more specific, NSAIDs generally impact COX-1 and COX-2 to varying degrees.

  • COX-1 is involved in the normal maintenance of bodily functions such as protecting the stomach lining.
  • COX-2 is involved in the production of prostaglandins that promote inflammation and pain in response to injury or infection.

By inhibiting the COX enzymes, NSAIDs reduce the production of prostaglandins, lessening the signs of inflammation. Different NSAIDs have varying levels of selectivity for COX-1 and COX-2 enzymes, which can affect their effectiveness and potential side effects.

For example, aspirin tends to inhibit COX-1 more strongly, which may increase the likelihood of developing gastrointestinal side effects. On the other hand, ibuprofen inhibits COX-2 more strongly, which may increase your risk for cardiovascular side effects.

NSAIDs vs Acetaminophen

Acetaminophen and NSAIDs are both commonly used for pain relief, but they work in different ways.

As mentioned, NSAIDs reduce pain and inflammation by blocking COX-1 and COX-2 enzymes.

Acetaminophen works primarily in the brain to block pain signals, but it does not have an anti-inflammatory effect like NSAIDs. Therefore, common brands of acetaminophen, such as Tylenol, are simply meant to block pain signals rather than treat the source of the pain through inflammation reduction.

Uses for NSAIDs

There are several different applications for NSAIDs, but here are the most common uses:

  • Pain relief: NSAIDs are often used to relieve mild to moderate pain, such as headaches, toothaches, menstrual cramps, and muscle aches.
  • Arthritis: NSAIDs are commonly used to relieve pain and inflammation associated with various types of arthritis, including osteoarthritis and rheumatoid arthritis.
  • Inflammation: NSAIDs are used to reduce swelling and inflammation caused by various conditions, such as tendonitis, bursitis, and gout.
  • Fever: NSAIDs can assist in reducing fever by blocking the manufacture of prostaglandins responsible for causing fever.
  • Post-surgery pain: NSAIDs can be used to manage pain following surgical procedures, such as dental extractions, tonsillectomies, and orthopedic surgeries.

Types of NSAIDs

A variety of prescription and over-the-counter anti-inflammatory medications are available to help manage acute and chronic inflammation. Let’s discuss the options in detail below.

Over-the-Counter NSAIDs

These anti-inflammatory drugs are available over-the-counter and do not require a prescription to purchase. Here are some of the most common examples to consider:

  • Ibuprofen: Advil, Motrin, Nuprin
  • Aspirin: Bayer, Bufferin, Excedrin (also contains acetaminophen), Ecotrin, Anacin
  • Naproxen: Aleve, Naprosyn, Anaprox, Mediproxen

Prescription NSAIDs

Prescription anti-inflammatories are potent medications that can only be obtained with a prescription from a doctor or healthcare professional. These NSAIDs are used to manage a range of serious conditions such as psoriatic arthritis, gout, rheumatoid arthritis, and other types of arthritis.

  • Celecoxib (Celebrex)
  • Diclofenac (Voltaren)
  • Etodolac (Lodine)
  • Fenoprofen (Nalfon)
  • Flurbiprofen (Ansaid)
  • Indomethacin (Indocin)
  • Ketoprofen (Orudis)
  • Meloxicam (Mobic)
  • Nabumetone (Relafen)
  • Naproxen (Naprosyn)
  • Piroxicam (Feldene)
  • Sulindac (Clinoril)
  • Tolmetin (Tolectin)

To use medications safely and effectively, it is essential to follow their instructions carefully and use them responsibly under the supervision of a healthcare professional.

Side Effects of NSAIDs

The adverse reactions of anti-inflammatories can differ based on the type of NSAID, the dose, and individual patient circumstances. Keep in mind, some users may suffer side effects not listed here.

Moreover, elderly individuals or people with pre-existing conditions may be more predisposed to the side effects of NSAIDs.

Stomach Problems

While NSAIDs can be effective for treating common inflammatory conditions, they can also have negative side effects on the gastrointestinal system. Some of the most common gastrointestinal side effects of NSAIDs include:

  • Stomach pain: NSAIDs can irritate the lining of the stomach, leading to pain and discomfort.
  • Nausea and vomiting: The irritation caused by NSAIDs can also lead to feelings of nausea and vomiting.
  • Indigestion and heartburn: NSAIDs can increase stomach acid production, leading to symptoms of indigestion and heartburn.
  • Gastric ulcers: In some cases, NSAIDs can cause ulcers to form in the lining of the stomach, which can lead to bleeding and other complications.
  • Gastrointestinal bleeding: NSAIDs can increase the risk of gastrointestinal bleeding, particularly in those who are elderly or have a history of gastrointestinal problems.

Talk to your healthcare provider if you have a history of gastrointestinal problems or are taking other medications that can increase your risk of gastrointestinal bleeding.

Heart Complications

Some NSAIDs are also associated with an increased risk of cardiovascular side effects. The most common cardiovascular side effects of NSAIDs include:

  • Heart attack: NSAIDs may increase the risk of heart attack, particularly in people with pre-existing heart conditions or those taking high doses for prolonged periods.
  • Stroke: NSAIDs have been linked to an increased risk of stroke, which may be more prominent in individuals with a history of cardiovascular disease.
  • Blood clots: Some NSAIDs have been associated with an increased risk of blood clots, which can lead to deep vein thrombosis (DVT) or pulmonary embolism (PE).
  • High blood pressure: NSAIDs may cause an increase in blood pressure, which may be more likely in those with pre-existing hypertension.
  • Heart failure: NSAIDs have been linked to an increased risk of heart failure, especially in individuals with pre-existing heart disease.

Again, the risk of cardiovascular side effects with NSAIDs varies depending on the individual, the dose, and the duration of use.

Other Side Effects

Some people may experience side effects unassociated with the cardiovascular or gastrointestinal systems. Here are a few examples of other side effects that can occur with NSAID use:

  • Kidney damage: NSAIDs can reduce blood flow to the kidneys, leading to kidney damage or failure.
  • Skin reactions: Some people may experience allergic reactions or other skin reactions, like rashes or hives while taking NSAIDs.
  • Liver damage: In rare cases, NSAIDs may contribute to liver damage or liver failure. This risk is higher in people who already have liver disease.
  • Headaches: While NSAIDs are often used to treat headaches, some people may actually experience headaches as a side effect of these medications.
  • Dizziness: NSAIDs may lead to dizziness when standing up or moving quickly. This is because these medications can affect blood pressure and circulation.
  • Allergic reactions: Some people may be allergic to NSAIDs and experience symptoms such as difficulty breathing, facial or throat swelling, or hives.

When to Seek Medical Attention

NSAIDs can cause a range of side effects, some of which can be severe and require immediate medical attention. Here are some of the severe side effects to watch for when taking NSAIDs:

  • Chest pain or shortness of breath
  • Sudden and severe headaches, confusion, or vision changes
  • Swelling of the hands, feet, or ankles
  • Signs of an allergic reaction, such as hives, rash, itching, or difficulty breathing
  • Nausea, vomiting, or severe stomach pain, which could indicate bleeding or an ulcer
  • Black, tarry stools, or bloody stools
  • Jaundice (yellowing of the eyes or skin), which may indicate liver damage
  • Rapid weight gain or fluid retention, which may indicate kidney problems
  • Persistent or severe dizziness or lightheadedness
  • Mood changes, such as depression or anxiety
  • Ringing in the ears
  • Irregular heartbeat
  • Unusual bruising or bleeding

If you encounter any of these severe side effects while taking NSAIDs, seek medical attention immediately.

Drug Interactions

NSAIDs are known to interact with a range of medications, making it important to consult with a medical professional before taking them in conjunction with other prescribed treatments. Some of the drugs that can interact with NSAIDs are:

  • Blood thinners: Taking NSAIDs with blood thinners such as warfarin or heparin can increase bleeding risk.
  • Immunosuppressant drugs: NSAIDs can reduce the effectiveness of immunosuppressant drugs used to prevent the rejection of transplanted organs.
  • Lithium: Taking NSAIDs with lithium can increase the levels of lithium in the body, leading to lithium toxicity.
  • Low-dose aspirin: Taking NSAIDs with low-dose aspirin may reduce the effectiveness of aspirin in preventing heart attacks and strokes.
  • SSRIs: Taking NSAIDs with SSRIs (selective serotonin reuptake inhibitors) can raise the probability of bleeding in the stomach or intestines.
  • Heart medications: Some heart medications, such as angiotensin-converting enzyme (ACE) inhibitors and beta blockers, may interact with NSAIDs making you more prone to kidney damage.

Some herbal supplements and OTC medicines may interact with NSAIDs as well, especially those with anticoagulant properties.

Who Should Avoid NSAIDs?

Although NSAIDs are useful in decreasing inflammation and pain in many people, certain groups should avoid using them. Some examples of people who shouldn’t take NSAIDs or who should use them under medical supervision only include:

  • People with a history of gastrointestinal bleeding or ulcers
  • Individuals who have had an allergic reaction to an NSAID in the past
  • Patients with advanced kidney disease or liver disease
  • Pregnant women in their third trimester or nursing mothers
  • People with a history of heart disease or stroke
  • Individuals taking anticoagulants or other meds that could heighten the risk of bleeding
  • Those with asthma or other respiratory conditions
  • People with hypertension (high blood pressure) that is not well-controlled
  • Individuals with a bleeding disorder or who are prone to bruising
  • Those who have undergone recent heart bypass surgery.

If you belong to any of these groups, be sure to speak with your healthcare provider before taking NSAIDs. They may recommend alternative pain relief options or natural remedies for inflammation that are safer for you.

Can Children Take NSAIDs?

When it comes to using NSAIDs to manage fever and pain in children, it’s crucial to prioritize safe and responsible medication practices. While NSAIDs are generally regarded as safe and effective for pediatric patients, it’s important to follow these important considerations:

  • Age: Children 2 years old or younger should not be given NSAIDs without a doctor’s approval.
  • Dose: NSAIDs should be given at the correct dose for a child’s weight, and the dose should not exceed the recommended maximum.
  • Duration of use: NSAIDs should only be used for a short duration unless directed by a doctor.
  • Underlying conditions: Children with certain medical conditions such as asthma, bleeding disorders, or kidney disease may not be able to take NSAIDs.
  • Possible side effects: Parents should be aware of possible side effects, including upset stomach or allergic reactions, and seek medical attention if necessary.
  • Alternative treatments: For mild pain or fever, alternative treatments such as acetaminophen or home remedies may be a safer option.

While NSAIDs can be safe and effective in children when used appropriately, it is always best to consult with a medical professional before giving any medication to a child.

Reye’s Syndrome

Administering aspirin to a child who is suffering from a viral infection, such as influenza or chickenpox, may augment the probability of contracting Reye’s Syndrome. Reye’s Syndrome is a rare yet severe condition that may lead to liver and brain impairment and can be fatal.

While the exact mechanism that triggers Reye’s Syndrome is yet to be comprehensively understood, it is hypothesized to be interrelated with the utilization of aspirin in children who have specific viral infections.

The usage of aspirin in children who have a viral infection may engender an accumulation of fatty acids in the liver and other organs, which may result in liver and brain damage. Thus, children who have a viral infection ought to be treated with other drugs such as ibuprofen or acetaminophen to alleviate pain and fever, which do not amplify the risk of Reye’s Syndrome.

For that reason, aspirin must be avoided in children unless it is explicitly recommended by a healthcare provider for a particular medical condition.

Tips for Using OTC NSAIDs

Below are some helpful tips to safely and effectively use over-the-counter NSAIDs:

  • Always follow the instructions on the label or those given by your healthcare provider.
  • Do not exceed the recommended dose or frequency of use.
  • Take NSAIDs with food or milk to reduce the risk of stomach irritation and ulcers.
  • Avoid using NSAIDs if you have a history of stomach ulcers, bleeding disorders, or kidney or liver disease, or if you are taking blood-thinning medications.
  • Do not use NSAIDs during pregnancy, especially during the last trimester, without consulting your healthcare provider.
  • Stop using NSAIDs immediately if you experience any adverse effects, such as stomach pain, heartburn, nausea, vomiting, dizziness, or rash.
  • Do not combine different NSAIDs or mix them with other medications without consulting your healthcare provider.
  • Talk to your healthcare provider before using NSAIDs if you have any underlying medical conditions or are taking other medications.
  • Store NSAIDs out of reach of children and pets.
  • Dispose of expired or unused NSAIDs properly by following local regulations.

Alternatives to NSAIDs

There are various options to consider instead of using NSAIDs for pain and inflammation management. Some examples include:

  • Acetaminophen: Acetaminophen is a fever reducer and pain reliever that is often used as an alternative to NSAIDs. It works by blocking pain signals in the brain and reducing fever.
  • Physical therapy: Physical therapy is a non-invasive treatment that involves exercises, stretches, and other techniques to reduce pain and improve mobility. It can be used to treat a variety of conditions, including musculoskeletal injuries, arthritis, and chronic pain.
  • Massage therapy: Massage therapy involves applying pressure and manipulating soft tissues to relieve pain and tension. It can be used to treat a variety of conditions, including muscle strains, tension headaches, and chronic pain.
  • Ice or heat therapy: Ice or heat therapy involves applying cold or warm compresses to an injured or painful area. Ice therapy is typically used to reduce swelling and inflammation, while heat therapy is used to relax muscles and improve circulation.

How to Decrease Inflammation Naturally

Learning how to reduce inflammation naturally is vital for long-term success and natural pain relief. Here are the most proven strategies for keeping inflammation at bay:

  • Reduce intake of inflammatory foods: Limit foods that cause inflammation including processed foods, sugar, and refined carbohydrates.
  • Start an anti-inflammatory diet: Switching to the anti-inflammatory diet includes incorporating foods that are rich in anti-inflammatory properties, such as fruits, vegetables, fatty fish, nuts, and seeds.
  • Control lifestyle factors: Manage stress levels, get enough sleep and exercise regularly to help reduce chronic inflammation in the body.
  • Take dietary supplements: Certain anti-inflammatory herbs and spices, such as ginger, curcumin, and piperine, also have anti-inflammatory effects and can be beneficial for reducing inflammation in the body.

Deciding on the best natural anti-inflammatory to buy can be a challenge. So we’ve provided you with a list of three of the most well-researched and time-tested supplements to reduce pain and inflammation.

Turmeric contains a powerful anti-inflammatory compound called curcumin, which blocks molecules responsible for inflammation. Curcumin also has antioxidant properties that can help protect cells from damage caused by inflammation.

Apple cider vinegar has been shown to have anti-inflammatory effects due to its high acetic acid content, which can inhibit certain enzymes involved in inflammation. Additionally, it can help promote a healthy gut microbiome, which has been linked to reduced inflammation in the body.

Elderberry contains antioxidants and anti-inflammatory compounds such as anthocyanins and quercetin that can help lower inflammation in the body. These compounds work by inhibiting the production of certain pro-inflammatory cytokines.

Nonsteroidal Anti-inflammatory Drugs: Final Thoughts

NSAIDs (nonsteroidal anti-inflammatory drugs) are a class of drugs widely used to treat pain, fever, and inflammation. They work by inhibiting the COX enzymes that produce prostaglandins, which contribute to these symptoms.

While effective, NSAIDs are not without risks, including gastrointestinal bleeding, kidney problems, and increased risk of heart attack and stroke. It is important to use these drugs safely and under the guidance of a healthcare provider.

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