If you’ve ever sprained your ankle, dealt with a headache, or spiked a fever, the odds are that you’ve turned to non-steroidal anti-inflammatory drugs, also known as NSAIDs, as a solution.

NSAIDs are a common, affordable, and effective way to relieve pain from headaches, body aches and sprains, menstruation pain, swelling, stiffness, arthritis, and fever. However, over-the-counter (OTC) NSAIDs can have side effects, especially if used for longer periods of time or at higher-than-recommended doses, so it’s important to know which OTC anti-inflammatories are right for you and your pain needs.

It can be tricky to navigate through all of the available choices for anti-inflammatories, so we’ve compiled some important information on NSAID choices below along with useful tips on how to use them safely and effectively.

What are your choices for OTC anti-inflammatories (NSAIDs)?

Although OTC anti-inflammatories are non-prescription, they can still be extremely effective at reducing pain, swelling, and fever. We’ve compiled a list of the most common over-the-counter anti-inflammatories and their prices as a guide to these medications.

• Ibuprofen: Ibuprofen, sold under the brand names Advil and Motrin, is one of the most widely-used nonsteroidal anti-inflammatory drugs (NSAIDs) available. Ibuprofen can also be used to treat pain from headaches or migraines, minor injuries, and reduce fever. It’s typically taken every 4-6 hours depending on strength. In terms of cost and effectiveness, generic ibuprofen is just as effective as Advil and Motrin and is far less expensive. For example, a 100-count bottle of 200mg Advil costs $9.26 at Walmart, while its generic counterpart costs $1.98 as of 2023.
  
• Naproxen: Naproxen, which is sold under the brand name Aleve, is also an NSAID and can be used to treat pain and inflammation. Naproxen is taken every 8 to 12 hours, while ibuprofen is taken every 4-6, so it’s slightly longer-lasting than ibuprofen. Generic naproxen is typically more affordable than its name-brand alternative Aleve. CVS sells a 100-count bottle of 220 mg naproxen sodium tablets for $9.79, while a 90-count bottle of 220mg Aleve costs $12.49 as of 2023.
  
• Aspirin: Aspirin, also known as acetylsalicylic acid (ASA), is a medication commonly used to reduce fever, headaches, arthritis pain, fevers, colds and flu symptoms, as well as heart conditions such as angina. High-dose aspirin is categorized as an NSAID, but low-dose aspirin is not typically strong enough to be considered an NSAID and is usually used as a type of antiplatelet medicine to help prevent cardiovascular problems. A 36-count bottle of 81mg aspirin costs $2.99, while its name-brand counterpart Bayers costs $3.59 as of 2023.
  
  

It’s important to note that acetaminophen, known more commonly by its brand name Tylenol, is not an NSAID (it doesn’t have anti-inflammatory properties). Acetaminophen is only used to treat pain and fever, so it can’t help with swelling or stiffness.

As with any over-the-counter medication, be sure to follow the directions on the bottle closely and to always touch base with your primary care provider before taking any new over-the-counter NSAIDs to make sure they are not inferring with any other medications that you’re taking. Most NSAIDs are normally taken with a full glass of water to help the medicine absorb properly.

What do you use OTC anti-inflammatories for?

OTC anti-inflammatories are used to treat many types of pain, including pain from headaches, body aches and sprains, menstruation pain, swelling, stiffness, arthritis, osteoarthritis, and joint pain, and fever.

NSAIDs work by blocking prostaglandins, which are hormone-like substances that enhance pain during inflammation by sensitizing your nerve endings. They also help to regulate your body temperature. NSAIDs act as an attenuating agent when they inhibit the effects of prostaglandins, alleviating your pain and bringing down your fever.

However, OTC anti-inflammatories are not intended for long-term pain relief, so it’s best to seek medical advice if your pain is persisting, as prescription-strength NSAIDs or other painkillers may be required.

When should you talk to a doctor?

It is always advisable to talk to your doctor before taking NSAIDs, especially if you have any pre-existing medical conditions or are taking other medications. Your doctor can help determine if NSAIDs are appropriate for your specific situation and recommend the appropriate dosage and duration of use. Additionally, they can advise you on potential side effects and interactions with other medications or supplements. If you experience any adverse reactions while taking NSAIDs, such as stomach pain, nausea, or vomiting, you should stop taking them and contact your doctor immediately.

What are the side effects and risks?

OTC anti-inflammatories are intended for short-term use, so it’s important to note that your risk of side effects increases the more you use them. Some of the side effects of NSAIDs include:

• Vomiting or nausea
  
• Diarrhea
  
• Gas
  
• Heartburn
  
• Stomach pain
• Kidney injury
• heart damage, especially in those who already have heart disease
• gastritis
• GI bleeding that can cause severe anemia
  
  

This is not a complete list of adverse reactions. Seek medical attention right away if you experience more serious side effects or symptoms such as blurred vision, black or tarry stools, jaundice (yellow skin or eyes), severe stomach pain, rash, hives, wheezing, or trouble breathing while taking OTC NSAIDs as they could be signs of an allergic reaction or life-threatening condition.

NSAIDs like aspirin, naproxen, and ibuprofen irritate the lining of your stomach, causing gastrointestinal issues like stomach ulcers, inflammation, and perforation of the intestines or stomach. These issues can sometimes be avoided by taking NSAIDs with food, milk or antacids, but if you have a history of gastrointestinal issues, talk to your doctor before taking OTC anti-inflammatories.

NSAIDS can cause high blood pressure (hypertension) and carry an increased risk of kidney problems, so you should talk to a healthcare professional if you are at risk or have a history of hypertension or decreased kidney function.

It’s important to note that ibuprofen and naproxen carry a black box warning from the Food and Drug Administration (FDA) due to the increased risk of heart attack and stroke while taking them. Talk to your doctor before taking NSAIDs if you are at risk of blood clots, stroke, heart attack, heart failure, heart disease, or other heart problems (or have a history of cardiovascular conditions), as it’s likely that you should avoid these medications.

Children and OTC NSAIDs

If you are caring for a child who is in pain or has a fever, your immediate instinct will most likely be to provide relief. However, if you’re considering giving your child OTC NSAIDs, it is best to talk to your doctor first. While NSAIDs are generally safe for children’s use, dosing amount and frequency can vary depending on your child’s age, weight, diagnosis, and the type of NSAID being used. Guidance on medications and age range are below:

• Ibuprofen: Ibuprofen (Advil, Motrin) can be used safely in infants 6 months and older
  
• Naproxen: Naproxen (Aleve) can be used by children over the age of 12. If your child is under the age of 12, you should talk to your doctor first.
  
• Aspirin: Aspirin (Bayers) should never be administered to children under the age of 18, as there is a risk of developing a rare condition called Reye’s Syndrome, especially if your child is recovering from a viral infection like the cold, flu or chickenpox.
  
  

As with adults, NSAIDs carry a risk of kidney damage, skin reactions, and stomach bleeding. These risks are greater if your child’s NSAID doses are higher or longer than recommended, so it is critical that you follow the recommended dosing instructions for your child’s age and weight on the label. Most children’s OTC NSAID medicine will also come with a measuring tool, which can look like a cap, syringe, or spoon. To avoid overdose, be sure to use these instead of common household teaspoons, which aren’t always accurate.

Are there prescription NSAIDs?

Yes, prescription NSAIDs do exist. However, prescription NSAIDs are stronger than their OTC counterparts, which means a licensed healthcare provider must authorize their use.

Some common NSAID prescription medications include:

• Ketorolac (generic Acuvail/ Acular)
  
• Meloxicam (generic Mobic)
  
• Celecoxib (generic Celebrex)
  
• Indomethacin (generic Tivorbex)
  
• Diclofenac (Voltaren)
  
• Fenoprofen (Nalfon)
  
• Flurbiprofen (Ocufen)
  
• Mefenamic acid (Ponstel)
  
• Oxaprozin (Daypro)
  
• Piroxicam (Feldene)
  
• Sulindac (Clinoril)
  
  

Looking for an NSAID prescription? 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 or order the medication to be delivered to your door for just $5. Book an online consultation with a licensed provider on Sesame today to determine whether or not prescription NSAIDs are right for you.

Note that all prescriptions are at the discretion of your healthcare provider. Providers on Sesame cannot prescribe controlled substances.

Sources:
- Aspirin (n.d.). medlineplus.gov/druginfo/meds/a682878.html
- Ibuprofen (n.d). medlineplus.gov/druginfo/meds/a682159.html
- Naproxen (n.d.). medlineplus.gov/druginfo/meds/a681029.html
- Non-Steroidal Anti-Inflammatory Drugs (n.d.). my.clevelandclinic.org/health/drugs/11086-non-steroidal-anti-inflammatory-medicines-nsaids
- NSAIDs: Do they increase my risk of heart attack and stroke? (n.d.). mayoclinic.org/diseases-conditions/heart-attack/expert-answers/nsaids-heart-attack-stroke/faq-20147557