NSAIDs: Non-Steroidal Anti-Inflammatory Drugs

Without even being aware of it, chances are that you, too, have used an NSAID at least once in your lifetime. NSAIDs are, after all, one of the most frequently used drug groups.

Being effective against many NSAIDs remains to be one of the first medications prescribed to humans.

Today, we are here to explain further the topic of NSAIDs and their use in everyday medicine. 

What are NSAIDs?

The term NSAIDs stands for non-steroidal anti-inflammatory drugs. A non-steroidal anti-inflammatory drug aims to relieve and reduce any present pain and inflammation in the body.

NSAIDs are a group of non-opioid analgesics. This means that NSAIDs, while being quite the effective painkillers, are different from popular opioids such as morphine. You may recognize morphine as an example of a popular opioid used to treat the more severe cases of pain. 

As the term suggests, they work by reducing the present inflammation in the body. Inflammation is our immune system’s way of reaction to a present infection and/or injury. Once inflammation occurs, the nerve receptors at the infection/injury site start sending pain signals to the brain to let it know that something is not right.

You may notice symptoms such as pain, swelling, and redness at the infection/injury site in a case of inflammation. With a powerful non-steroidal anti-inflammatory drug, these symptoms are expected to go away in a few days. 

NSAIDs are famous for being generally safe and quite effective in the treatment of any pain and inflammation. They also tend to have fewer adverse effects as compared to the well-known corticosteroids. One of the best things about NSAIDs is how quickly they can relieve any present symptoms and improve your condition. This is one of the reasons why so many people refer to NSAIDs in their time of need.

While there are many different groups of NSAIDs, all NSAIDs belong to one of the two classes – selective and non-selective non-steroidal anti-inflammatory medication. To understand the difference between the two, we first need to explain a little bit more about how NSAIDs work. 

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How do NSAID’s work?

To soothe the present inflammation, NSAIDs inhibit the production of the so-called prostaglandins. Prostaglandins are chemicals that trigger the inflammation associated with an infection and/or injury. But prostaglandins are quite useful to our bodies as well.

At the same time, they protect the mucosal lining of our stomach and intestines, maintain normal kidney function, and promote blood clotting. Both types of prostaglandins, however, reduce the blood flow to our kidneys. 

To inhibit the prostaglandins synthesis, NSAIDs focus on blocking an enzyme called COX or cyclooxygenase. There are two different forms of the COX enzyme. The COX-1 and the COX-2 enzyme have different actions in the body. The COX-1 produces the helpful prostaglandins, the ones that protect your stomach’s lining. On the other hand, the COX-2 produces the ones that play a role in terms of inflammation. 

Knowing this, researchers have come to the idea of producing selective and non-selective NSAIDs. The majority of NSAIDs and non-selective, also known as non-specific NSAIDs. A non-selective NSAID interferes with both the COX-1 and COX-2 enzymes. While working to reduce the present inflammation and pain, the non-selective anti-inflammatory drug is also exposing your stomach to an increased risk of gastrointestinal bleeding and stomach ulcers.

Non-selective and selective NSAID’s

Ibuprofen, Naproxen, and Diclofenac are all examples of non-selective NSAIDs. Your doctor may recommend using a proton-pump inhibitor along with the NSAID of choice to reduce the risk of gastrointestinal bleeding and stomach ulcers. This is a generally safe and effective method in terms of the prevention of gastrointestinal issues.  

On the other hand, a selective NSAID, otherwise known as a selective COX-2 inhibitor, blocks the COX-2 enzyme more than the COX-1 enzyme. With the use of a COX-2 inhibitor, you get to reduce your inflammation without increasing your risk for kidney disease and other potential adverse effects. As of today, there is only one COX-2 selective NSAID available in the United States. That happens to be the NSAID called celecoxib (Celebrex). Celebrex is only available with a valid doctor’s prescription. 

Over-the-counter and prescription NSAIDs

That brings us to yet another classification of the famous NSAIDs. NSAIDs are divided into two groups – over-the-counter and prescription NSAIDs. Celebrex, while being the only selective NSAID, is certainly not the only prescription anti-inflammatory drug.

Many other non-selective drugs require a doctor’s prescription as well. Naproxen, Indomethacin, Etodolac, and Oxaprozin are some popular prescription NSAIDs. Ibuprofen, Aspirin, and Naproxen Sodium, on the other hand, are all OTC NSAIDs. 

Aspirin remains to exist as one of the most commonly used and unique NSAIDs. We are talking about the only NSAID that inhibits blood clots’ formation for up to 4-7 days. By doing so, Aspirin is the perfect drug designed to prevent blood clots in patients with heart disease, heart attack, and stroke. 

Oral and topical NSAIDs

NSAIDs are currently available in two forms – oral and topical. The oral NSAIDs are taken by mouth, orally, as directed by your doctor. These can be taken with or without food by drinking lots of fluids. These are available in the form of tablets, syrup, powder, and capsules. 

On the other hand, topical NSAIDs come in the form of creams, gels, and patches. They were first introduced on the market back in 2007. This was also the year when topical NSAIDs were first approved in the U.S. All topical NSAIDs require a doctor’s prescription. They are usually recommended to arthritis patients to soothe their pain and stiffness by locally applying a topical NSAID.

Topical NSAIDs are also commonly used in the case of sprains, strains, and sports injuries such as overuse injuries. In the majority of cases, diclofenac and ibuprofen topical medications are used. 

A topical NSAID is said to have a better risk: benefit ratio as compared to the traditional oral NSAIDs. This indicates that the risk for adverse events is significantly lower with the use of topical NSAIDs. This concept is well explained in a 2016 study published in the Seminars in Arthritis and Rheumatism. This is also the reason why many doctors and patients prefer the topical NSAIDs over oral ones. 

What are NSAIDs used to treat?

As stated before, the traditional NSAID is used as a pain reliever, in addition to reducing fever and soothing any present inflammation.

Chronic pain can be caused by a number of reasons, but it can also be easily treated with the use of a proper NSIAD. For example, NSAIDs are used in the case of arthritis, headaches, toothache, lower back pain, cold, etc. Let’s take a look at some of the most common NSAIDs. We will also explain why each of them is used for.

  • Aspirin is available over-the-counter and by prescription. An everyday painkiller is used to treat just about anything from a toothache, headache, fever, and even period pain. This NSAID is also recommended to patients with an increased cardiovascular risk. As a blood thinner, Aspirin prevents blood clots from forming. It is usually prescribed immediately after a heart attack and stroke to avoid the further formation of blood clots and heart tissue death. As much help as it can be, Aspirin is not safe for everyone. It is very important that you consult your doctor about your use of Aspirin. 

  • Ibuprofen is used in the treatment of a range of health issues. Patients are given Ibuprofen to treat their post-surgical pain, inflammatory disease pain, strains, sprains, and even arthritis. Like Aspirin, Ibuprofen is also available over-the-counter or by prescription. 

  • Naproxen is used to treat any kind of pain and inflammation that originates from your muscles and/or joints. It efficiently helps achieve pain relief in those with arthritis such as rheumatoid arthritis, psoriatic arthritis, and osteoarthritis. Naproxen can also cause pain relief in those struggling with sprains, strains, and even period pain.

  • Celebrex is a non-steroidal anti-inflammatory drug used specifically to treat the pain caused by different types of arthritis. Once again, the symptoms of rheumatoid arthritis and osteoarthritis can be soothed with the use of yet another NSAID. Research has shown that Celebrex has exceptional results in those struggling with tenderness, swelling, and decreased range of motion due to their arthritis. Ankylosing spondylitis, which is a chronic inflammatory rheumatic disorder that affects the spine, is also commonly treated with a Celebrex prescription. 

Prostatitis and NSAIDs

Prostatitis refers to the prostate gland’s inflammation, a small gland located under the bladder in men. The prostate gland produces up to 50-70 percent of the fluid that semen is made out of.

Unfortunately, this small gland is often affected by health issues such as inflammation. There are several different types of prostatitis, including acute, chronic, and asymptomatic prostatitis. Prostatitis causes symptoms such as pain, fever, chills, and problems related to urination.  

Different causes can cause this inflammatory process. Two common causes happen to be gonorrhea and chlamydia, which lead to acute or chronic bacterial prostatitis. The treatment course for prostatitis includes the use of antibiotics. However, the doctor may also prescribe additional medication. Alpha-blockers and NSAIDs are commonly used in the case of prostatitis. 

Ibuprofen, Aspirin, and other NSAIDs can help relieve the present inflammation. NSAIDs seem to be especially helpful in cases of chronic bacterial prostatitis, chronic prostatitis, and asymptomatic prostatitis. These conditions are less effectively treated with the use of antibiotics, which is why NSAIDs seem to be the perfect answer for the present inflammation and pain. COX-2 selective NSAIDs have been shown to relieve the symptoms for up to 66% of chronic prostatitis patients.

A placebo study published in 2003 compared the effects of rofecoxib and placebo in 161 chronic prostatitis patients. The results showed that the patients who received 50 mg of rofecoxib experienced a significant improvement in their symptoms and quality of life. This serves to show that rofecoxib and other NSAIDs are a good treatment option for those with chronic prostatitis. 

Precautions for using NSAIDs

While on the treatment with NSAIDs, it is good to keep some key points in mind. In the following, we will share some general guidelines that can help reduce the likelihood of potential side-effects that we will discuss shortly.

  • Inform your doctor and/or pharmacist in case you are using any other over-the-counter and/or prescribed medications;

  • Always follow your doctor’s/pharmacist’s instructions regarding your use of NSAIDs;

  • Whenever possible, always take the lowest dose possible for the shortest period of time;

  • Do not intentionally alter the recommended dosage on your own;

  • NSAIDs are not recommended for children under the age of 16 and adults over the age of 65. If you belong to any of these age groups, please consult your doctor before taking any NSAID, even if that happens to be ibuprofen or Aspirin;

  • Avoid drinking excessive amounts of alcohol during your treatment with NSAIDs. Alcohol alone does not seem to interact with NSAIDs. However, excessive amounts of alcohol can further irritate your stomach, causing digestive issues;

  • Do not take more than one NSAID at once unless your doctor has instructed you otherwise;

  • If you are supposed to be taking an NSAID over a long period of time, consult your doctor about the possibility of using a selective COX-2 inhibitor instead. You may also need to take additional medication to help protect your digestive health;

  • Patients with heart disease need to consult a doctor before using an NSAID;

  • Do not take NSAIDs in case you have a known allergy to any NSAID.

Side-effects for using NSAIDs and long-term safety

With NSAIDs, it is difficult to determine how exactly your body will react to the medication. It all depends on the dosage, chosen medication, duration of treatment, and so much more.

While some side-effects are possible, this does not necessarily mean that everyone will experience such side-effects. In the case that you do experience even the slightest side-effects, make sure that you consult your doctor as soon as possible. 

Experts suggest that patients who receive high doses of NSAIDs for a long time are more likely to experience side effects than those who receive lower doses for a shorter period of time.

Prescription NSAIDs tend to cause more severe side-effects as compared to the over-the-counter ones. The potential side-effects can vary from mild to more severe. In the following, we will take a look at some of the most commonly mild and severe side-effects caused by NSAIDs.

  • Mild side-effects
    • Drowsiness;

    • Dizziness;

    • Headaches;

    • Nausea;

    • Vomiting;

    • Heartburn;

    • Decreased appetite; 

    • Rash;

    • Diarrhea/constipation, etc.

  • Severe side-effects
    • Liver problems;

    • Kidney problems;

    • Heart problems;

    • Allergic reaction;

    • Stomach ulcers, etc.

Further side effects

In some cases, NSAIDs can affect your kidney function, increasing the likelihood of kidney disease. It is said that long-term use of NSAIDs can lead to nephrotic syndrome. Nephrotic syndrome refers to a collection of symptoms that indicate kidney damage. As a result, you may experience significant swelling, high blood lipids, and protein in the urine, among other symptoms. 

NSAIDs can also increase your blood pressure levels. Anyone who struggles with high blood pressure should avoid taking NSAIDs without consulting their doctor. But this is also another way in which NSAIDs’ use affects our kidneys and contributes to the development of kidney disease.

NSAIDs reduce the blood flow to your kidneys, which leads to a fluid build-up in your body since your kidneys are not working as hard as they did before. Long-term use of NSAIDs will then lead to high blood pressure and thus significantly damage your kidneys. Those with known kidney disease are advised against the use of NSAIDs to avoid further kidney damage.

The use of NSAIDs has also been linked to myocardial infarction, with higher doses of NSAIDs being listed as a potential risk factor for this condition. Acute myocardial infarction is a more professional way of referring to a heart attack. The risk of stroke is said to increase as well due to the use of non-aspirin NSAID. However, such events have not been linked to the use of low doses of Aspirin, making Aspirin a safe prevention method for heart attack and stroke. 

NSAIDs are not used before any surgery. If you are using any NSAID, you must discontinue your use before the actual surgery. This will significantly reduce your risk of increased bleeding after your surgery. NSAIDs are also not used after every surgery, especially if the patient has undergone heart surgery, such as coronary artery bypass graft surgery. 

You can be potentially allergic to NSAIDs. Shortness of breath, loss of conciseness, facial swelling, and skin rash are all common symptoms of an allergic reaction. In case of an allergic reaction, please ask for immediate medical help and discontinue your use of NSAIDs. 

NSAID overdose is possible. In the case of NSAID toxicity, symptoms such as nausea, blurred vision, drowsiness, and seizures are to be expected. If you are experiencing any of these symptoms or you are worried about ingesting a larger than normal dose of any NSAID, please contact your doctor right away.


NSAIDs are a well-known group of drugs. Your doctor may prescribe you a selective or a non-selective NSAID. These will help soothe any pain, inflammation, and swelling associated with a number of health issues.

While some NSAIDs are available OTC, you may need a prescription for others. It is always recommended to consult your doctor when choosing an NSAID. That way, you can choose the right NSAID for you and experience the least side-effects possible. 


  1. Gwee, K., Goh, V., Lima, G., & Setia, S. (2018). Coprescribing proton-pump inhibitors with nonsteroidal anti-inflammatory drugs: Risks versus benefits. Journal of Pain Research, Volume 11, 361-374. doi:10.2147/jpr.s156938
    Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5817415/
  2. Rannou, F., Pelletier, J., & Martel-Pelletier, J. (2016). Efficacy and safety of topical NSAIDs in the management of osteoarthritis: Evidence from real-life setting trials and surveys. Seminars in Arthritis and Rheumatism, 45(4). doi:10.1016/j.semarthrit.2015.11.007
    Retrieved from https://pubmed.ncbi.nlm.nih.gov/26806189/
  3. Ishiguro, H., & Kawahara, T. (2014). Nonsteroidal anti-inflammatory drugs and Prostatic diseases. BioMed Research International, 2014, 1-6. doi:10.1155/2014/436123
    Retrieved from https://www.hindawi.com/journals/bmri/2014/436123/
  4. NICKEL, J. C., PONTARI, M., MOON, T., GITTELMAN, M., MALEK, G., FARRINGTON, J., . . . DRISKO, J. (2003). A randomized, placebo Controlled, Multicenter study to evaluate the safety and efficacy of Rofecoxib in the treatment of chronic nonbacterial prostatitis. Journal of Urology, 169(4), 1401-1405. doi:10.1097/01.ju.0000054983.45096.16
    Retrieved from https://www.auajournals.org/doi/10.1097/01.ju.0000054983.45096.16
  5. Dixit, M., Doan, T., Kirschner, R., & Dixit, N. (2010). Significant acute kidney injury due to non-steroidal ANTI-INFLAMMATORY DRUGS: Inpatient setting. Pharmaceuticals, 3(4), 1279-1285. doi:10.3390/ph3041279
    Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4034033/
  6. Mérida, E., & Praga, M. (2019). NSAIDs and nephrotic syndrome. Clinical Journal of the American Society of Nephrology, 14(9), 1280-1282. doi:10.2215/cjn.08090719
    Retrieved from https://cjasn.asnjournals.org/content/14/9/1280

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