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NSAIDs Overview

Nonsteroidal anti-inflammatory drugs reduce the inflammation that accompanies arthritis.

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Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most-used drugs to ease the pain, inflammation and stiffness that come with arthritis, bursitis and tendinitis. Most NSAIDs are cheap and often among the first medicines prescribed for people with achy joints. NSAIDs also are used to reduce fevers, and aspirin is used in low doses to protect against heart disease. They are available to take by mouth or to rub on the skin over painful joints and muscles.

NSAIDs work by preventing an enzyme called cyclooxygenase (COX) from making hormone-like chemicals called prostaglandins. Prostaglandins are one of the body’s biggest contributors to inflammation.  

Your body makes two different kinds of cyclooxygenase: COX-1 helps protect your stomach lining and COX-2 plays a role in inflammation. Most NSAIDs – including aspirin, ibuprofen and naproxen -- are nonspecific, meaning they inhibit both COX-1 and COX-2. While this helps relieve pain and inflammation, it also leaves your stomach vulnerable to ulcers and bleeding.

A specific type of NSAID, called COX-2 selective inhibitors, block the COX-2 enzyme more than the COX-1 enzyme. The only COX-2 selective NSAID currently available in the United States is the prescription drug celecoxib (Celebrex). It is often prescribed for long-term use for people with arthritis because it may be safer for the stomach than other NSAIDs. But all NSAIDs, including celecoxib, carry some risk of stomach problems.  

Choosing an NSAID

Many NSAIDs work similarly, but some people respond better to one than another. Each has its own strength and instructions for how often to take it. If you’re just starting on NSAIDs, your doctor will likely prescribe ibuprofen, because it is inexpensive and easy to get. If you don’t get good relief, your doctor can switch you to another option.

Ibuprofen and naproxen are available in both prescription and over-the-counter (OTC) versions. OTC versions come in about half the dose of the prescription versions. At these lower doses, NSAIDs provide only pain relief. The anti-inflammatory benefits of NSAIDs are achieved at the higher doses found in prescription medicines.

The pain-relieving effects of NSAIDs begin quickly -- within a few hours.  Heat and swelling will take longer to get better. It takes up to two weeks before you see full benefits.

If you need short-term relief while your other arthritis medicines take effect or during a flare, your doctor may prescribe a short-acting NSAID that has to be taken several times per day. But if you’ll be taking the drugs for an extended time, your doctor may select one that needs to be taken only once or twice per day. Your doctor may choose celecoxib for you to help protect your stomach.

Don’t Take Too Much

Like all medicines, NSAIDs have risks to go along with the anti-inflammatory and pain-relieving benefits. They can cause stomach distress and bleeding, easy bruising, and heart and kidney problems. The higher your dose and the longer you take NSAIDs, the more likely you’ll experience negative effects. Read more about risk and benefits as well as side effects and solutions of NSAIDs.

Before you start taking any medicine, read the label carefully to be certain you’re not taking more than one medicine that contains an NSAID. They may be found in medications for upset stomach, allergy, cough, cold and sleep problems. And talk to your doctor before taking both acetaminophen (Tylenol) and an NSAID.

 To learn more about specific NSAIDs, see the NSAIDs Drug Guide.

Currently available NSAIDs include:

  • Aspirin – Salicylate
  • Celecoxib – COX-2 inhibitor
  • Diclofenac epolamine
  • Diclofenac potassium
  • Diclofenac sodium
  • Diflunisal
  • Etodolac
  • Fenoprofen calcium
  • Flurbiprofen
  • Ibuprofen
  • Ibuprofen with famotidine
  • Indomethacin
  • Ketoprofen
  • Meclofenamate sodium
  • Mefenamic acid
  • Meloxicam
  • Nabumetone
  • Naproxen/naproxen sodium
  • Naproxen and esomeprazole magnesium
  • Oxaprozin
  • Piroxicam
  • Sulindac
  • Tolmetin sodium
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