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NSAIDs (Nonsteroidal anti-inflammatory drugs
Please select a link below to read about available generic and trade name medications.
| Generic Name | Trade Name |
 Celecoxib |
Celebrex® |
| Diclofenac |
Voltaren® |
| Diflunisal |
Dolobid® |
| Etodolac |
Lodine® |
| Fenoprofen |
Nalfon® |
| Flurbiprofen |
Ansaid® |
| Ibuprofen |
Advil®, Motrin® |
| Indomethacin |
Indocin® |
| Ketoprofen |
Orudis®, Oruvail® |
| Meloxicam |
Mobic® |
| Nabumetone |
Relafen® |
| Naproxen |
Aleve®, Anaprox®, Naprelan®, Naprosyn® |
| Oxaprozin |
Daypro® |
| Piroxicam |
Feldene® |
| Salsalate |
Disalcid® |
| Sulindac |
Clinoril® |
| Tolmetin |
Tolectin® |
| Valdecoxib |
Bextra® |
NSAIDs
Read about dosage, potential side effects, special instructions and more below.
NSAIDs ("en-SAYDS") is short for nonsteroidal anti-inflammatory drugs. NSAIDs reduce inflammation and swelling, and relieve pain and fever.
These agents work by blocking an enzyme called cyclooxygenase (COX) that promotes the formation of prostaglandin in the body. Prostaglandins cause inflammation. Some prostaglandins; however, also have beneficial effects on the platelets, stomach and kidneys. Therefore, blocking their formation can lead to bleeding, stomach irritation and ulcers, an elevated blood pressure and fluid retention. In other words, NSAIDs have excellent beneficial effects, but the way they work also can produce side effects.
There are at least two types of the COX enzyme. The COX-1 enzyme is responsible for many of the beneficial effects, whereas the COX-2 enzyme has been attributed to many undesirable effects such as pain and inflammation.
Some of the newer NSAIDs (Celebrex®, Bextra®) are more "selective" for the COX-2 enzyme and theoretically will have more anti-inflammatory effects without the side effects of the older "nonselective" NSAIDs. These drugs are used to treat a wide variety of disorders, including tendonitis, bursitis, gout and many types of arthritis.
There are wide dose ranges with most of the NSAIDs. In general, one should use the lowest dose for the shortest period of time with these agents. This is particularly important in elderly patients who are more susceptible not only to ulcers but to fluid retention, elevated blood pressure and kidney abnormalities. Rarely are two NSAIDs used together.
Thrombotic events (heart attacks, blood clots, strokes) have been reported in patients taking COX-2-specific NSAIDs, perhaps they don’t have any effect on platelet cells and don’t “thin the blood” as traditional NSAIDs do. In some cases, particularly with the COX-2 NSAIDs, it may be necessary to combine aspirin with the NSAID if your doctor wants to "thin the blood" for reducing the risk of heart attacks or strokes.
NSAIDs are considered safe, perhaps too safe, by patients and doctors. The main risk of these agents is stomach ulcers.
Particularly at risk are people who have had ulcers, patients on coumadin (a blood thinning agent) and steroids, elderly patients and patients taking high doses of the medication over long periods of time. Warning signs might include heartburn, indigestion, abdominal pain or black stools, but perhaps half of patients who develop ulcers have no warning signs. If you are at a significant risk, your doctor might prescribe an ulcer prevention medication with your NSAID to try to minimize your risk of developing an ulcer.
Less common side effects include kidney or liver abnormalities, fluid retention and leg swelling, worsening of hypertension or heart failure, or worsening of asthma. Call your doctor if you have questions about your medicine and if it might be causing these or other side effects.
It is also important for your doctor to know all of your medications including other over-the-counter medications such as aspirin, Advil® or Aleve®, that can interact with NSAIDs.
These agents should relieve your inflammation and pain. A trial period of 10 to 14 days is usually needed to see if the medication will work. There is great individual variance between these medications. More than 20 NSAIDs are available in the United States.
A "trial and error" method frequently is required for you and your doctor to determine the best drug for you and the best dose. All the NSAIDs are considered equally effective and the potential advantage of the newer COX-2 specific drugs is they have fewer side effects on the stomach and no effect on the cell clotting cells (platelets). This benefit; however, comes with considerable increased cost and is not necessary for the majority of patients using these medications.
Little monitoring is required, as the main side effects are on the stomach and cannot be monitored by tests. In some patients, a kidney (creatinine) or liver (ALT) blood test should be monitored.
Let your doctor know if you gain weight, your legs swell, your blood pressure elevates or you get stomach pain. If you take Coumadin your doctor may need to check if the NSAID has affected the blood level.
Always take your NSAIDs with food. Call your doctor if you develop possible side effects from these agents. Ask your doctor about using over-the-counter medications such as ibuprofen or naproxen. Acetaminophen (Tylenol®), taken as directed, may be used with the NSAIDs.
Some patients with asthma or hives, or who are allergic to aspirin, may have similar problems with the NSAIDs. Discuss this with your doctor.
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