NSAIDs: Uses, common brands, and safety info

If you have ever experienced any type of pain or inflammation, chances are you have taken an NSAID medication for short-term pain relief (analgesic effect). NSAIDs are nonsteroidal anti-inflammatory drugs. Used in children and adults, they help many different ailments that can cause pain or inflammation. Read on to learn all about NSAIDs—including common brand names, uses, and safety information. This chart lists the most common NSAIDs and pricing information. 

What are NSAIDs?

Nonsteroidal anti-inflammatory drugs are popular medications that treat pain and inflammation from a variety of conditions such as arthritis, back pain, and headaches. They can also help reduce a fever. Although there are many prescription NSAIDs, some are available over-the-counter (OTC) like aspirin and ibuprofen. 

Note that Tylenol, which contains acetaminophen, is often mentioned with these drugs, but Tylenol is not an NSAID.

How do NSAIDs work?

NSAIDs work by blocking enzymes called COX-1 and COX-2. COX stands for cyclooxygenase. These enzymes make prostaglandins, which cause pain and inflammation. By blocking these enzymes, your body produces fewer prostaglandins, causing less pain and inflammation. (Celebrex is an NSAID that is a COX-2 inhibitor. By blocking only COX-2, there may be fewer adverse effects on the stomach.)

NSAIDs are effective and can often control pain, sparing patients from taking stronger medication like opioids, which have more severe side effects and a high potential for abuse and dependence.

When you have mild to moderate pain or inflammation that requires an NSAID, other measures may help as well. Ask your healthcare provider for medical guidance on other pain management tactics such as ice or heat, physical therapy, and rest.

What are NSAIDs used for?

NSAIDs are useful for a variety of conditions that cause mild to moderate pain and inflammation, such as:

• Backaches

• Muscle aches

• Sports injuries/sprains

• Headaches

• Fever 

• Dental pain

• Rheumatoid arthritis

• Juvenile rheumatoid arthritis

• Osteoarthritis

• Tendonitis

• Ankylosing spondylitis 

• Gout pain

• Bursitis 

• Menstrual cramps

As specific indications vary among products, ask your healthcare professional for medical advice on which pain reliever would be best for your condition. 

Who can take NSAIDs?

Men

Most adult men can take NSAIDs unless they fall under any of the restricted groups below. 

Women

Most adult women can take NSAIDs unless they fall into a restricted category listed below. Pregnant women should not take NSAIDs in the third trimester of pregnancy because they can cause serious harm to an unborn baby.

Children

Some nonprescription NSAIDs, like Advil and Motrin, are available for children older than 6 months, but be sure to check the appropriate dose with your pediatrician or pharmacist. Dosing varies by formulation, age, and weight. Some formulations are more concentrated, meaning the child would get more medicine in a smaller quantity. That is why it is very important to read the Drug Facts label for the particular product, and double-check with your healthcare provider if you are unsure. Also, use a dosing cup or oral syringe to measure the appropriate dose. Do not use kitchen measuring spoons, as these can be inaccurate for measuring medication. 

Although Aleve is available OTC, it should not be used in children younger than 12 years old. 

Prescription NSAIDs vary in terms of ages and indications, so ask your healthcare provider if you have questions.

Seniors

NSAIDs are on the Beers List of medications that are potentially inappropriate for older adults. There is a higher risk of stomach bleed or ulcers in people who are older than 75 years old. Taking a proton pump inhibitor like Prilosec can lower the risk of effects on the stomach, but does not eliminate the risk. Older adults should also avoid NSAIDs due to increased risk for heart failure, fluid retention, and kidney damage.

Are NSAIDs safe?

NSAID restrictions

Do not take NSAIDS if you:

• Are allergic to any NSAIDs.

• Have a history of asthma or allergic reactions from aspirin or other NSAIDs. 

• Are about to have (or have just had) CABG surgery.

• Are in the third trimester of pregnancy. If you are in the first or second trimester, or if you are breastfeeding, ask your healthcare professional for medical advice. 

NSAID warnings

All NSAIDs have a black box warning. A black box warning is the most serious warning as required by the FDA (United States Food and Drug Administration). This warning includes:

• Cardiovascular risk: NSAIDs cause an increased risk of blood clots, heart attack, and stroke, which can be fatal. The risk is present early in treatment, and the risk increases the longer the drug is used. NSAIDs should not be used before or after coronary artery bypass graft (CABG) surgery.

• Gastrointestinal (GI) risk: NSAIDs increase the risk of bleeding, irritation of the stomach lining/ulcers, and perforation of the stomach and intestines. This can be fatal. These GI complications can happen at any time during NSAID use and without warning. Risk factors include older adults and patients with a history of GI bleed and/or ulcers.

Other warnings include:

• In rare cases, liver problems can occur. They can be serious or fatal. Notify your doctor if you have symptoms like nausea, tiredness, itching, lower stomach pain, jaundice, or diarrhea.

• Blood pressure should be monitored during treatment.

• Because NSAIDs increase the risk for heart failure and edema, they should generally be avoided in people with severe heart failure. 

• Long-term use can cause kidney problems and should generally be avoided in patients with advanced kidney disease.

• Get emergency medical help if signs of an anaphylactic reaction occur, such as itching, difficulty breathing, or swelling of the lips, face, or tongue.

• NSAIDs can cause serious skin reactions such as Stevens-Johnson Syndrome or toxic epidermal necrolysis (TEN). These can be fatal and occur without warning. Stop taking the NSAID and get emergency help if you have a skin reaction. Do not take NSAIDs if you have had a previous skin reaction to an NSAID.

• NSAIDs can cause anemia. The risk of bleeding from NSAIDs increases with use of certain drugs like corticosteroids, anticoagulants (such as warfarin), antiplatelets, or SSRI or SNRI antidepressants. 

• If you take an NSAID for a long time, ask your doctor about lab tests. Because of all the risks associated with NSAIDs, it is best to take the lowest dose possible, for the shortest amount of time. If you are using an OTC NSAID, ask your doctor before using it for more than 10 days. Chronic pain may require a different medication.

Tell your healthcare provider about all the medications you take, including prescription, OTC, and vitamins, so he or she can make sure that an NSAID is safe with the other medications you take. NSAIDs interact with certain medications like SSRI or SNRI antidepressants, anticoagulants, lithium, ACE inhibitors, ARBs, and diuretics.

NSAIDs should not be used in the third trimester of pregnancy, because they can cause severe harm to an unborn baby. 

NSAID recalls

• Ketorolac injection recall (March 2020)

• Ketorolac injection recall (April 2019)

• Ibuprofen oral recall (January 2019)

• Infants’ ibuprofen recall (December 2018)

Vioxx and Bextra were both COX-2 inhibitors that were removed from the market due to serious heart problems.

Can you take NSAIDs while pregnant or breastfeeding?

Do not take NSAIDs in the third trimester of pregnancy. These drugs can cause life-threatening harm to an unborn baby. If you are in the first or second trimester, or if you are already taking an NSAID and find out that you are pregnant, consult your healthcare provider for guidance. 

If you are breastfeeding, consult your healthcare professional for medical advice. 

Are NSAIDs controlled substances?

No, NSAIDs are not controlled substances.

Common NSAIDs side effects

NSAID pain relievers are often tolerated well but can cause many side effects, some of which can be serious. The most common side effects include GI (gastrointestinal) side effects such as abdominal pain, constipation, diarrhea, gas, heartburn, nausea, and vomiting. Dizziness is also a common side effect. 

Other, serious side effects can occur. These can include:

• Heart problems like heart attack, stroke, high blood pressure (hypertension), or heart failure

• Kidney or liver problems

• GI problems like bleeding and ulcers in the stomach and intestine

• Low red blood cells

• Life-threatening skin or allergic reactions

• Asthma attacks in asthma patients

If you have any of these symptoms, get emergency medical treatment:

• Difficulty breathing or shortness of breath

• Chest pain 

• Weakness in one side of the body

• Slurred speech

• Swelling of the face or throat

Stop taking your NSAID and call your doctor right away if you have any of these symptoms:

• Nausea 

• Feeling unusually tired or weak

• Itching, skin rash, or blisters with fever

• Yellowing of the skin or white of eyes

• Flulike symptoms

• Vomiting blood

• Black, tarry, or bloody stools

• Swelling of the arms/legs/hands/feet

This is not a complete list of side effects. Consult your healthcare provider for a full list of side effects. 

How much do NSAIDs cost?

NSAIDs are a popular choice among healthcare providers because they are not only effective but inexpensive as well. You can purchase OTC NSAIDs for $5 and up, depending on package size and formulation. Prescription-strength NSAIDs are also economical, with prices varying by product, strength, and quantity. You can always use a free SingleCare card to save money on your NSAID prescription and even OTC forms with a valid prescription.