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Nonsteroidal anti-inflammatory drugs

Medically reviewed on Mar 22, 2018 by C. Fookes, BPharm

Other names: NSAIDs

What are nonsteroidal anti-inflammatory drugs (NSAIDs)?

Nonsteroidal anti-inflammatory agents (usually abbreviated to NSAIDs) are a group of medicines that relieve pain and fever and reduce inflammation.

There are nearly two dozen different NSAIDs available, but they all work in the same way, and that is by blocking a specific group of enzymes called cyclo-oxygenase enzymes, often abbreviated to COX enzymes. These enzymes are responsible for the production of prostaglandins. Prostaglandins are a group of compounds with hormone-like effects that control many different processes such as inflammation, blood flow, and the formation of blood clots.

What are nonsteroidal anti-inflammatory agents used for?

NSAIDs are used to treat mild-to-moderate pain that arises from a wide range of conditions such as headaches, menstruation, migraines, osteoarthritis or rheumatoid arthritis, sprains and strains, and toothache.

Aspirin is a NSAID that is used in small doses to lower the risks of having a heart attack or a stroke caused by a blood clot. It may also be given as a single dose at the time of a heart attack to improve outcomes. This is because it irreversibly inhibits the COX-1 enzyme.

What are the differences between nonsteroidal anti-inflammatory agents?

NSAIDs may be grouped according to their preference for COX-1 and COX-2 enzymes. Those that favor COX-1 are more likely to cause gastrointestinal side effects. Those that favor COX-2 have a higher risk of cardiovascular effects but less gastrointestinal effects. Higher dosages of NSAIDs tend to result in more COX-2 enzyme inhibition (and more cardiovascular side effects), even in those NSAIDs traditionally seen as low risk (such as ibuprofen). NSAIDs with higher activity against COX-2 enzymes should be used with caution in people with cardiovascular disease or at increased risk of cardiovascular disease.

Both types of COX enzymes produce prostaglandins; however, the main function of COX-1 enzymes is to produce baseline levels of prostaglandins that activate platelets and protect the lining of the gastrointestinal tract, whereas COX-2 enzymes are responsible for releasing prostaglandins after infection or injury.

Most NSAIDs inhibit both enzymes to a certain extent.

List of Common NSAIDs

Generic name Brand names
More COX-1 selective*
flurbiprofen Ansaid
ketorolac Only generic
ketoprofen Orudis, Oruvail
tolmetin Tolectin DS
aspirin Bayer, Ascriptin, Bufferin Low Dose, Durlaza, Ecotrin, Ecpirin, Halfprin, Miniprin
Relatively nonselective
ibuprofen Advil, Motrin, Genpril, Midol IB, Proprinal
naproxen Aleve, Flanax Pain Reliever, Midol Extended ReleaseNaprosyn
Less than 50-fold COX-2 selective*
indomethacin Indocin, Tivorbex
sulindac Clinoril
piroxicam Feldene
mefenamic acid Ponstel
meloxicam Mobic, Vivlodex
diclofenac Cataflam, VoltarenZipsor, Zorvolex
celecoxib Celebrex
etodolac Lodine
More than 50-fold COX-2 selective
etoricoxib Not approved in the U.S.
lumiracoxib Not approved in the U.S.
rofecoxib Withdrawn because of safety concerns

*Ranked in order from the least COX-2 activity to the highest within that group.

Note that selectivity rankings vary depending on resources used. This table is based on a best effort accumulation of data.

Are nonsteroidal anti-inflammatory agents safe?

NSAIDs are one of the most widely prescribed group of medicines; however, they are associated with some serious side effects.

NSAIDs can increase your risk of a fatal heart attack or stroke. The risk increases the higher the dosage and the longer the length of time you remain on an NSAID for. People with pre-existing heart disease are more at risk and certain NSAIDs, such as diclofenac and celecoxib, have been linked to more heart-related side effects than others. NSAIDs should never be used just before or after heart bypass surgery (coronary artery bypass graft, or CABG).

Gastrointestinal (GI) side effects are also common, and usually related to dosage and duration of treatment although some NSAIDs, such as ketorolac, aspirin and indomethacin, are associated with a higher risk. Elderly people or those taking other medicines that irritate the stomach are more likely to experience life-threatening GI side effects, such as stomach or intestinal bleeding.

Most NSAIDs are not suitable for children or adolescents under the age of 18 years. Ibuprofen is the only NSAID approved for children aged three months and older.

Most NSAIDs should not be taken during the last three months of pregnancy or while breastfeeding except on a doctor’s advice.

What are the side effects of nonsteroidal anti-inflammatory agents?

NSAIDs can potentially cause a range of side effects, especially when used at higher than recommended dosages for long periods of time.

Gastrointestinal side effects that may occur include bloating, diarrhea, constipation, irritation of the lining of the stomach, nausea or vomiting.

NSAIDs may also affect kidney function and reduce how quickly blood flows through the kidneys. They may cause retention of sodium and water which can lead to edema and high potassium levels. Occasionally, they may cause more serious damage to the kidneys.

Some NSAIDs, particularly diclofenac and those that are selective for COX-2 enzymes, have a high risk of cardiovascular thrombotic events such as a heart attack or stroke. Other heart-related side effects such as high blood pressure, congestive heart failure, and palpitations have also been reported.

In addition, some people taking NSAIDs have experienced asthma attacks, bleeding, fatigue, headache, insomnia, low neutrophil levels, urticaria (hives), vertigo and seizures. Reye’s syndrome, a life-threatening condition that causes swelling in the liver and brain and is mostly associated with aspirin use in young children has also been reported.

 

 

List of Nonsteroidal anti-inflammatory drugs:

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Drug Name Reviews Avg. Ratings
Advil Children's (Pro)
generic name: ibuprofen
0 reviews
   
10
Flanax Pain Reliever
generic name: naproxen
1 review
   
10
Motrin Infant Drops
generic name: ibuprofen
1 review
   
10
Children's Motrin
generic name: ibuprofen
3 reviews
   
9.8
Clinoril (Pro)
generic name: sulindac
4 reviews
   
9.2
Orudis (Pro)
generic name: ketoprofen
2 reviews
   
9.2
Orudis KT
generic name: ketoprofen
4 reviews
   
9.0
Tolectin DS
generic name: tolmetin
1 review
   
9.0
Lodine XL
generic name: etodolac
0 reviews
   
8.5
Nalfon (Pro)
generic name: fenoprofen
1 review
   
8.5
Advil Liqui-Gels (Pro)
generic name: ibuprofen
13 reviews
   
8.4
Cataflam (Pro)
generic name: diclofenac
35 reviews
   
8.4
Motrin IB (Pro)
generic name: ibuprofen
5 reviews
   
8.4
Ansaid (Pro)
generic name: flurbiprofen
3 reviews
   
8.2
Arthrotec (Pro)
generic name: diclofenac / misoprostol
40 reviews
   
8.2
Zorvolex (Pro)
generic name: diclofenac
20 reviews
   
8.2
Cambia (Pro)
generic name: diclofenac
33 reviews
   
8.1
Feldene (Pro)
generic name: piroxicam
12 reviews
   
8.1
Ibu-8
generic name: ibuprofen
0 reviews
   
8.0
Lodine (Pro)
generic name: etodolac
14 reviews
   
8.0
Nuprin
generic name: ibuprofen
0 reviews
   
8.0
Naprelan (Pro)
generic name: naproxen
14 reviews
   
7.9
Indocin (Pro)
generic name: indomethacin
25 reviews
   
7.7
Vimovo (Pro)
generic name: esomeprazole / naproxen
28 reviews
   
7.7
Voltaren (Pro)
generic name: diclofenac
126 reviews
   
7.7
Sprix (Pro)
generic name: ketorolac
28 reviews
   
7.5
Indocin SR (Pro)
generic name: indomethacin
7 reviews
   
7.4
Voltaren-XR (Pro)
generic name: diclofenac
5 reviews
   
7.4
Naprosyn (Pro)
generic name: naproxen
30 reviews
   
7.3
Toradol (Pro)
generic name: ketorolac
178 reviews
   
7.3
Zipsor (Pro)
generic name: diclofenac
33 reviews
   
7.3
IBU (Pro)
generic name: ibuprofen
1 review
   
7.2
Motrin (Pro)
generic name: ibuprofen
14 reviews
   
7.2
Anaprox-DS
generic name: naproxen
5 reviews
   
7.0
EC-Naprosyn
generic name: naproxen
0 reviews
   
7.0
Ibu-6
generic name: ibuprofen
0 reviews
   
7.0
Mobic (Pro)
generic name: meloxicam
119 reviews
   
7.0
Oruvail
generic name: ketoprofen
2 reviews
   
7.0
Relafen (Pro)
generic name: nabumetone
32 reviews
   
7.0
Toradol IV / IM
generic name: ketorolac
13 reviews
   
7.0
Aleve
generic name: naproxen
110 reviews
   
6.9
Anaprox
generic name: naproxen
7 reviews
   
6.7
Advil (Pro)
generic name: ibuprofen
25 reviews
   
6.6
Midol Extended Relief
generic name: naproxen
1 review
   
6.3
Daypro (Pro)
generic name: oxaprozin
4 reviews
   
6.2
Ponstel (Pro)
generic name: mefenamic acid
17 reviews
   
6.2
Duexis (Pro)
generic name: famotidine / ibuprofen
23 reviews
   
6.0
IBU-200
generic name: ibuprofen
0 reviews
   
5.5
Dolobid
generic name: diflunisal
4 reviews
   
5.2
All Day Pain Relief
generic name: naproxen
0 reviews
   
4.5
Advil Migraine
generic name: ibuprofen
1 review
   
3.7
A-G Profen
generic name: ibuprofen
0 reviewsAdd rating
Actiprofen
generic name: ibuprofen
0 reviewsAdd rating
Addaprin
generic name: ibuprofen
0 reviewsAdd rating
Advil Infant's Concentrated Drops (Pro)
generic name: ibuprofen
0 reviewsAdd rating
Aflaxen
generic name: naproxen
0 reviewsAdd rating
All Day Relief
generic name: naproxen
0 reviewsAdd rating
Caldolor (Pro)
generic name: ibuprofen
0 reviewsAdd rating
Dyloject
generic name: diclofenac
0 reviewsAdd rating
Fenortho (Pro)
generic name: fenoprofen
0 reviewsAdd rating
Genpril
generic name: ibuprofen
0 reviewsAdd rating
Haltran
generic name: ibuprofen
0 reviewsAdd rating
Ibu-4
generic name: ibuprofen
0 reviewsAdd rating
Ibu-Tab
generic name: ibuprofen
0 reviewsAdd rating
Midol IB
generic name: ibuprofen
0 reviewsAdd rating
Motrin Childrens
generic name: ibuprofen
0 reviewsAdd rating
Motrin Junior Strength
generic name: ibuprofen
0 reviewsAdd rating
NeoProfen (Pro)
generic name: ibuprofen
0 reviewsAdd rating
Prevacid NapraPAC (Pro)
generic name: lansoprazole/naproxen
0 reviewsAdd rating
ProFeno (Pro)
generic name: fenoprofen
0 reviewsAdd rating
Proprinal
generic name: ibuprofen
0 reviewsAdd rating
Q-Profen
generic name: ibuprofen
0 reviewsAdd rating
Tivorbex (Pro)
generic name: indomethacin
1 reviewAdd rating
Tolectin 600
generic name: tolmetin
0 reviewsAdd rating
Vivlodex (Pro)
generic name: meloxicam
0 reviewsAdd rating

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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