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What are NSAIDs and how do they work?
Prostaglandins are a family of chemicals that are produced by the cells of the body and have several important functions. They promote inflammation that is necessary for healing, but also results in pain, and fever; support the blood clotting function of platelets; and protect the lining of the stomach from the damaging effects of acid.
Prostaglandins are produced within the body's cells by the enzyme cyclooxygenase (COX). There are two COX enzymes, COX-1 and COX-2. Both enzymes produce prostaglandins that promote inflammation, pain, and fever. However, only COX-1 produces prostaglandins that support platelets and protect the stomach. Nonsteroidal anti-inflammatory drugs (NSAIDs) block the COX enzymes and reduce prostaglandins throughout the body. As a consequence, ongoing inflammation, pain, and fever are reduced. Since the prostaglandins that protect the stomach and support platelets and blood clotting also are reduced, NSAIDs can cause ulcers in the stomach and promote bleeding.
What NSAIDs are approved in the United States?
The following list is an example of NSAIDs available:
- celecoxib (Celebrex)
- diclofenac (Cambia, Cataflam, Voltaren-XR, Zipsor, Zorvolex)
- diflunisal (Dolobid - discontinued brand)
- etodolac (Lodine - discontinued brand)
- ibuprofen (Motrin, Advil)
- indomethacin (Indocin)
- ketoprofen (Active-Ketoprofen [Orudis - discontinued brand])
- ketorolac (Toradol - discontinued brand)
- nabumetone (Relafen - discontinued brand)
- naproxen (Aleve, Anaprox, Naprelan, Naprosyn)
- oxaprozin (Daypro)
- piroxicam (Feldene)
- salsalate (Disalsate [Amigesic - discontinued brand])
- sulindac (Clinoril - discontinued brand)
- tolmetin (Tolectin - discontinued brand)
Quick GuideMigraine or Headache? Migraine Symptoms, Triggers, Treatment
What are the side effects of NSAIDs?
NSAIDs are associated with several side effects. The frequency of side effects varies among NSAIDs.
Common side effects are
Other important side effects are:
- kidney failure (primarily with chronic use),
- liver failure,
- ulcers, and
- prolonged bleeding after injury or surgery.
NSAIDs can cause fluid retention which can lead to edema, which is most commonly manifested by swelling of the ankles.
WARNING: Some individuals are allergic to NSAIDs and may develop shortness of breath when an NSAID is taken. People with asthma are at a higher risk for experiencing serious allergic reaction to NSAIDs. Individuals with a serious allergy to one NSAID are likely to experience a similar reaction to a different NSAID.
Use of aspirin in children and teenagers with chickenpox or influenza has been associated with the development of Reye's syndrome, a serious and sometimes fatal liver disease. Therefore, aspirin and non-aspirin salicylates (for example, salsalate [Amigesic]) should not be used in children and teenagers with suspected or confirmed chickenpox or influenza.
NSAIDs increase the risk of potentially fatal, stomach and intestinal adverse reactions (for example, bleeding, ulcers, and perforation of the stomach or intestines). These events can occur at any time during treatment and without warning symptoms. Elderly patients are at greater risk for these adverse events. NSAIDs (except low dose aspirin) may increase the risk of potentially fatal heart attacks, stroke, and related conditions. This risk may increase with duration of use and in patients who have underlying risk factors for heart and blood vessel disease. Therefore, NSAIDs should not be used for the treatment of pain resulting from coronary artery bypass graft (CABG) surgery.
For what conditions are NSAIDs used?
NSAIDs are used primarily to treat inflammation, mild to moderate pain, and fever.
Specific uses include the treatment of:
Ketorolac (Toradol) is only used for short-term treatment of moderately severe acute pain that otherwise would be treated with narcotics.
Aspirin (also an NSAID) is used to inhibit the clotting of blood and prevent strokes and heart attacks in individuals at high risk for strokes and heart attacks.
NSAIDs also are included in many cold and allergy preparations.
Celecoxib (Celebrex) is used for treating familial adenomatous polyposis (FAP) to prevent the formation and growth of colon polyps.
Are there any differences between NSAIDs?
NSAIDs vary in their potency, duration of action, how they are eliminated from the body, how strongly they inhibit COX-1 versus COX-2 and their tendency to cause ulcers and promote bleeding. The more an NSAID blocks COX-1, the greater is its tendency to cause ulcers and promote bleeding. One NSAID, celecoxib (Celebrex), blocks COX-2 but has little effect on COX-1, and is therefore further classified as a selective COX-2 inhibitor. Selective COX-2 inhibitors cause less bleeding and fewer ulcers than other NSAIDs.
Aspirin is a unique NSAID, not only because of its many uses, but because it is the only NSAID that inhibits the clotting of blood for a prolonged period of time (4 to 7 days). This prolonged effect of aspirin makes it an ideal drug for preventing blood clots that cause heart attacks and strokes.
Most NSAIDs inhibit the clotting of blood for only a few hours. Ketorolac (Toradol) is a very potent NSAID and is used for moderately severe acute pain that usually requires narcotics. Ketorolac causes ulcers more frequently than other NSAID. Therefore, it is not used for more than five days. Although NSAIDs have a similar mechanism of action, individuals who do not respond to one NSAID may respond to another.
With which drugs do NSAIDs interact?
NSAIDs reduce blood flow to the kidneys and therefore reduce the action of diuretics ("water pills") and decrease the elimination of lithium (Eskalith, Lithobid) and methotrexate (Rheumatrex, Trexall). As a result, the blood levels of these drugs may increase as may their side effects.
NSAIDs also decrease the ability of the blood to clot and therefore increase bleeding. When used with other drugs that also increase bleeding (for example, warfarin [Coumadin]), there is an increased likelihood of serious bleeding or complications of bleeding. Therefore, individuals who are taking drugs that reduce the ability of blood to clot should avoid prolonged use of NSAIDs.
NSAIDs increase the negative effect of cyclosporine on kidney function.
Persons who have more than three alcoholic beverages per day may be at increased risk of developing stomach ulcers when taking NSAIDs.
Medically reviewed by Eni Williams, PharmD
Reference: FDA Prescribing Information.
Quick GuideMigraine or Headache? Migraine Symptoms, Triggers, Treatment
Nonsteroidal antiinflammatory drugs (NSAIDs) are a class of drugs are used to treat inflammation, mild to moderate pain, and fever. Examples of the most common NSAIDs include: aspirin salsalate (Amigesic), diflunisal (Dolobid), ibuprofen (Motrin), ketoprofen (Orudis), nabumetone (Relafen), piroxicam (Feldene), naproxen (Aleve, Naprosyn,) diclofenac (Voltaren), indomethacin (Indocin), sulindac (Clinoril), tolmetin (Tolectin), etodolac (Lodine), ketorolac (Toradol), oxaprozin (Daypro), celecoxib (Celebrex).
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Treatment & Diagnosis
- Leg Pain
- Buttock Pain
- Hand Pain
- Wrist Pain
- Joint Pain
- Sore Tongue
- Shoulder Pain
- Stiff Neck
- Joint Stiffness
- Lower Back Pain
- Knee Pain
- Neck Pain (Cervicalgia)
- Swollen Joints
- Joint Redness
- Pleurisy (Pleuritis)
- Chronic Sore Throat
- Common Cold
- Joint Warmth
- PMS (Premenstrual Syndrome)
- Gum Disease
- Dry Socket
- West Nile Virus
- Abscessed Tooth
- Doctor: Checklist to Take To Your Doctor's Appointment
- Headaches FAQs
- Back Pain FAQs
- Pain FAQs
- Ankylosing Spondylitis FAQs
- How To Reduce Your Medication Costs
- Pharmacy Visit, How To Get The Most Out of Your Visit
- Indications for Drugs: Approved vs. Non-approved
- Pain (Acute and Chronic)
- Generic Drugs, Are They as Good as Brand-Names?
- Medication Disposal - What to Do with Old or Unusable Medication
- Dangers of Mixing Medications
- Drugs: Buying Prescription Drugs Online Safely
- Drugs: The Most Common Medication Errors
- Cox-2 Inhibitors Dilemma: What Patients Should Do
- The Cox-2 Inhibitors Controversy: Q&A with Dr. Shiel
- Pain Management Over-The-Counter
- Celebrex - New Arthritis Drug
Medications & Supplements
- naproxen, Anaprox, Naprelan, Naprosyn, Aleve
- ibuprofen (Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever, and others)
- Drugs: What You Should Know About Your Drugs
- ketorolac (Toradol brand has been discontinued in the US)
- Cox-2 Inhibitors
- celecoxib, Celebrex
- indomethacin, Indocin, Indocin-SR (Discontinued Brand in U.S.)
- diclofenac, Voltaren, Cataflam, Voltaren-XR, Cambia
- Drug Interactions
- aspirin (acetylsalicylic acid, Bayer, Ecotrin, and others)
- piroxicam, Feldene
- Oxycodone vs. Tramadol for Pain
- nabumetone, Relafen (Discontinued)
- etodolac, Lodine (Discontinued)
- flurbiprofen (Ansaid is a discontinued brand)
- Aspirin Therapy (Guidelines for Heart Attack and Stroke Prevention)
- oxaprozin, Daypro
- diflunisal, Dolobid
- phenylbutazone, Butazolidine
- sulindac, Clinoril
- ketoprofen (Discontinued brands: Nexcede, Orudis, Oruvail, Actron)
- OTC Pain Relievers and Fever Reducers
- fenoprofen, Nalfon
- tolmetin, Tolectin (Discontinued Brand)
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- choline magnesium salicylate, Trilisate
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- valdecoxib, Bextra
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Daily Health News
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Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
Reference: FDA Prescribing Information.
Top Nonsteroidal Antiinflammatory Drugs Related ArticlesComplete List
Ankylosing SpondylitisWhat is ankylosing spondylitis? Take this quiz to learn the causes, symptoms, and treatments for this painful disorder.
Dengue FeverDengue fever is contracted from the bite of a striped Aedes aegypti mosquito. Symptoms and signs of dengue include headache, fever, exhaustion, severe joint and muscle pain, rash, and swollen glands. Since dengue is caused by a virus, there is no specific medicine to treat it. Treatment instead focuses on relieving the symptoms.
EndometriosisEndometriosis implants are most commonly found on the ovaries, the Fallopian tubes, outer surfaces of the uterus or intestines, and on the surface lining of the pelvic cavity. They also can be found in the vagina, cervix, and bladder. Endometriosis may not produce any symptoms, but when it does the most common symptom is pelvic pain that worsens just prior to menstruation and improves at the end of the menstrual period. Other symptoms of endometriosis include:
- Pain during sex
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- Cramping or pain during bowel movements or urination
Treatment of endometriosis can be with medication or surgery.
Gout PictureCondition characterized by abnormally elevated levels of uric acid in the blood, recurring attacks of joint inflammation (arthritis), deposits of hard lumps of uric acid in and around the joints, and decreased kidney function and kidney stones. See a picture of Gout and learn more about the health topic.
Gout SlideshowGout attacks (gouty arthritis) are caused by crystals of uric acid deposits. Learn about symptoms, causes, treatments and medication for this painful condition.
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Headaches QuizIf you're plagued with headaches, our Headaches Quiz may help you identify causes, triggers, symptoms, and treatments for headache pain caused by different types of headaches such as migraines, sinus, cluster, tension, or stress.
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HysteroscopyHysteroscopy is a minimally invasive surgical procedure performed to diagnose and treat women's conditions such as:
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- congenital abnormalities of the female genital tract,
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Treatment options vary depending on the type and severity of symptoms. Medications may be prescribed to manage MS symptoms.
Nerve Pain SlideshowLearn about nerve pain symptoms, causes, and treatment options. Discover medications, treatments, and natural remedies that can offer relief for dealing with the symptoms caused by nerve pain.
Take the Pain QuizIs pain all in the brain? Take the Pain Quiz to learn everything you've ever wanted to know about the unpleasant sensation we call pain.
Psoriatic Arthritis SlidesWhat is psoriatic arthritis? Psoriatic arthritis is an arthritis type that comes with psoriasis (skin inflammation). Psoriatic arthritis symptoms often affect hands and fingers. Learn more symptoms of psoriatic arthritis here.
Rheumatoid ArthritisRheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.
Sciatica SlideshowSciatica pain radiates from the lower back toward the feet. Sciatica may feel like a cramp in the leg, burning, tingling, pins and needles, or numbness. Learn about sciatica causes, exercises, treatment and pain relief.
Sore Throat Home Remedies and Treatment
These 25 sore throat natural and home remedies can help soothe throat pain, and heal a sore throat caused by viral (common cold, flu, mumps); bacterial (tonsillitis, some STDs); some toxins; allergens; trauma or injury; or "mechanical causes" (breathing through the mouth). Typical symptoms of a sore throat include throat pain, coughing, sneezing, fever, and swollen lymph nodes. Natural and home remedies to soothe sore throat pain include:
- Essential oils
- Licorice gargles
- Slippery elm leaves
- Raw garlic
- Throat Coat tea
TonsillectomyTonsillectomy is the surgical removal of both tonsils. A tonsillectomy may be performed in cases of recurrent tonsillitis, or treat sleep apnea and some speech disorders.
Upper Respiratory Infection
An upper respiratory infection is a contagious infection of the structures of the upper respiratory tract, which includes the sinuses, nasal passages, pharynx, and larynx. Common causes of an upper respiratory infection include bacteria and viruses such as rhinoviruses, group A streptococci, influenza, respiratory syncytial, whooping cough, diphtheria, and Epstein-Barre. Examples of symptoms of upper respiratory infection include:
- Sore throat
- Nasal congestion
Treatment of upper respiratory infections are based upon the cause. Generally, viral infections are treated symptomatically with over-the-counter (OTC) medication and home remedies.