What are NSAIDs?

Nonsteroidal anti-inflammatory drugs (NSAIDs) treat inflammation and pain symptoms caused by various medical conditions. NSAIDs are also known as pain relievers or painkillers.

“Nonsteroidal anti-inflammatory drug” is a broad umbrella term used to classify many different types of drugs with varying mechanisms of action in the body. These are some of the most widely used and available drugs on the marketplace. Recent reports estimate that 30 million people worldwide use some form of NSAID daily. These drugs work by slowing the inflammatory response in the body—the immune system’s natural defense mechanism against harmful stimuli.

NSAIDs are widely available over-the-counter (OTC) as medicated pills, capsules, liquids, creams, and gels. In addition to OTC NSAIDs, prescription-strength drugs are available via a health care provider’s orders. These are used to treat chronic and severe pain. Prescription NSAIDs are not generally given for mild to moderate pain symptoms. For more information about over-the-counter anti-inflammatory drugs, check out our blog.

What are NSAIDs used to treat?

NSAIDs are used to treat a wide range of health conditions and symptoms. NSAIDs are meant to reduce inflammation in the body. Inflammation is your immune system’s natural response to harmful pathogens and stimuli. When bacteria, viruses, toxins, and injuries damage cells in the body, inflammatory cells (prostaglandins) are released by your immune system to target the damage and start the healing process.

Sometimes, your body makes a mistake and continues sending inflammatory cells into the rest of your body, even when there is no damage or injury. This is known as chronic inflammation. Rheumatoid arthritis, for example, occurs when inflammatory cells continue to attack joint tissue. This can cause long-term pain and musculoskeletal deformities.

NSAIDs work by slowing this immune response. Specifically, these drugs inhibit the production of an enzyme called cyclooxygenase. There are two types of this enzyme: COX-1 and COX-2. COX-1 plays a role in maintaining the stomach lining, regulating kidney function, and platelet aggregation. COX-2 triggers the production of prostaglandins, cells that cause pain and swelling at inflammation sites. The vast majority of NSAIDs are non-selective in their inhibition of cyclooxygenase. This means that they block the production of both COX-1 and COX-2. There are a few prescription NSAIDs that target only COX-2.

Some conditions that may be treated with NSAIDs include:

• Arthritis, rheumatoid arthritis, osteoarthritis, and tendonitis
  
• Back pain
  
• Muscle aches and pains
  
• Joint pain
  
• Fever
  
• Flu
  
• Common cold
  
• Menstrual pain and cramping
  
• Sprains and strains
  
• Dental pain
  
• Gout
  
  

This is not a complete list of all conditions that may be treated with NSAIDs, but these are among the most common.

It is important to note that NSAIDs rarely “cure” the underlying condition requiring treatment. These drugs are generally used to reduce symptoms caused by the conditions listed above.

What are the different types of NSAIDs?

Various strengths of NSAIDs are used to treat different conditions. OTC NSAIDs may be recommended for mild-to-moderate symptoms, while prescription-strength NSAIDs may be prescribed for severe pain relief or chronic inflammation (like that caused by arthritis).

These drugs are generally supplied as oral pills, capsules, topical gels, or creams. The Food and Drug Administration (FDA) has approved these drugs to reduce fever and relieve pain.

OTC NSAIDs include:

• Ibuprofen (generic for Advil and Motrin)
  
• Naproxen (generic for Naprosyn, Aleve, and Flanax)
  
• Aspirin (generic for Ecotrin and Bayer)
  
  

Over-the-counter NSAIDs are widely available and can be found in most pharmacies, grocery stores, and convenience stores.

Health care professionals use prescription-strength NSAIDs to treat moderate-to-severe pain symptoms and chronic inflammation (usually caused by arthritis or another underlying medical condition).

FDA-approved prescription NSAIDs include:

• Celecoxib (generic for Celebrex)
  
• Diclofenac (generic for Voltaren)
  
• Indomethacin (generic for Tivorbex)
  
• Ketorolac (generic for Acuvail/ Acular)
  
• Meloxicam (generic for Mobic)
  
• Nabumetone (generic for Relafen)
  
• Ketoprofen (generic for Frotek)
  
  

Celecoxib (Celebrex) is currently the only FDA-approved COX-2 inhibitor on the market. Because COX-2 inhibitors only target the COX-2 enzyme, these drugs have a lower risk of side effects like gastrointestinal distress. Celecoxib use, however, has some serious risk factors. This drug may increase the risk of cardiovascular disease and stroke. COX-2 NSAIDs have also been shown to cause potentially serious complications, such as stomach ulcers (peptic ulcers). Celecoxib is commonly prescribed to help reduce the symptoms of back pain. If you are at risk for heart disease, a heart attack, or stroke, seek medical advice from your health care provider before starting treatment with celecoxib.

Acetaminophen (Tylenol) is not a nonsteroidal anti-inflammatory drug. While this medication works similarly to NSAIDs, it is classified as an analgesic.

What are the common side effects of NSAIDs?

NSAIDs have been shown to cause adverse effects when taken in high doses or over an extended period of time. You should seek medical advice before starting treatment with any form of NSAID.

Common side effects reported from NSAID use include:

• Gas
  
• Indigestion
  
• Diarrhea
  
• Constipation
  
• Heartburn
  
• Nausea
  
• Vomiting
  
  

If you begin to experience a skin rash, hives, swelling, or difficulty breathing after taking an NSAID, you should seek medical attention immediately. These are early signs of an allergic reaction—a potentially life-threatening medical emergency.

Inform your provider if you are currently managing any medical conditions before starting treatment with an NSAID. You should also tell them about any and all medications and supplements you are taking before taking NSAIDs. This will help prevent any serious drug interactions.

NSAID use may be discouraged if you:

• Take low-dose aspirin or warfarin for blood clots
  
• Take medication for high blood pressure (hypertension) and heart failure
  
• Take other kinds of NSAIDs
  
• Have a history of kidney disease or fluid retention (edema)
  
• Have a history of peptic ulcers and other gastrointestinal problems
  
• Are over 65
  
• Are pregnant or breastfeeding
  
  

OTC NSAIDs are generally safe for most adults in the short term. Seek medical advice if your treatment requires more than 3–7 days of NSAID use.

Do I need a prescription for NSAIDs?

It depends! As detailed above, several over-the-counter NSAID options are available for purchase without a prescription. These drugs can be found in most pharmacies, grocery stores, and convenience stores.

Certain conditions require a higher dose of NSAID than you can purchase over the counter. If you are managing moderate-to-severe symptoms or symptoms that have lasted longer than a week, you should seek medical advice from a health care provider to discuss prescription NSAID options.

Providers on Sesame can write a prescription – or refill an existing one – during a virtual or in-person visit. Depending on the medication, you can arrange for same-day pickup at a pharmacy near you. Book an online consultation with a real, licensed provider on Sesame today to determine whether or not NSAIDs are right for you.

If you are experiencing fever symptoms or pain symptoms related to an injury or illness, book an online doctor visit on Sesame to discuss your symptoms and possible treatment options with a licensed health care provider right away.

Sources:

• Ghlichloo I, Gerriets V. Nonsteroidal Anti-inflammatory Drugs (NSAIDs). https://www.ncbi.nlm.nih.gov/books/NBK547742/.
  
• Wongrakpanich, S., Wongrakpanich, A., Melhado, K., & Rangaswami, J. A Comprehensive Review of Non-Steroidal Anti-Inflammatory Drug Use in The Elderly. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5772852/.
  
• Saad J, Mathew D. Nonsteroidal Anti-Inflammatory Drugs Toxicity. https://www.ncbi.nlm.nih.gov/books/NBK526006/.
  
• Marcum, Z. A., & Hanlon, J. T. Recognizing the Risks of Chronic Nonsteroidal Anti-Inflammatory Drug Use in Older Adults. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3158445/.
  
• Ngo VTH, Bajaj T. Ibuprofen. https://www.ncbi.nlm.nih.gov/books/NBK542299/.
  
• Ross R. What are NSAIDs? https://orthoinfo.aaos.org/en/treatment/what-are-nsaids/.
  

Sesame content is not intended to be a substitute for professional medical advice, diagnosis or treatment. If you have a medical concern, it is critical to seek the advice of your physician or another qualified health provider with any questions. If you are facing a medical emergency, call 911 or visit the nearest emergency room immediately.

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