NSAIDs (nonsteroidal anti-inflammatory drugs)

medication bottles with pills

NSAIDs (nonsteroidal anti-inflammatory drugs) are some of the most commonly used pain medicines in adults. They are also a common treatment for chronic (long-term) health problems, such as arthritis (rheumatoid arthritis, osteoarthritis, and others) and lupus. NSAIDs block proteins, called enzymes, in the body that help make prostaglandins. Prostaglandins are a group of naturally occurring fatty acids that play a role in pain and inflammation. NSAIDs also can decrease inflammation, such as fever, swelling, and redness.

Traditional NSAIDs include aspirin, ibuprofen (Advil, Motrin, etc.), naproxen (e.g., Aleve), and many other generic and brand name drugs. Celecoxib (Celebrex) belongs to a newer class of NSAIDs, which doctors call a “COX-2 inhibitor,” and is designed to avoid upset stomach.

How to Take It

Each NSAID has its own dose (strength) and interval for how often to take the drug. The dosage size of over-the-counter medicine (those sold without a doctor’s prescription) is often less than prescription versions of the same medicine. NSAIDs start to work quickly, most often within a few hours. How fast they take affect depends on the intended effect. Pain control tends to occur much quicker than anti-inflammatory effects, such as improvement of swelling.

Do not mix an over-the-counter NSAID with a prescribed NSAID or take more than the recommended dose of the NSAID. Doing so could increase your chance of side effects. Doctors have long warned not to give aspirin to children under age 12, but teens with a virus also should avoid drugs containing aspirin. There is a risk of Reye’s syndrome, a rare but deadly illness that can affect the brain and liver.

Side Effects

All drugs have a risk of side effects, including NSAIDs. It is important to understand the risks and benefits of a drug before deciding to take it. Possible risks of all NSAIDs include: stomach problems (such as bleeding, ulcer, and stomach upset), kidney problems, high blood pressure or heart problems, fluid retention (causing swelling, such as around the lower legs, feet, ankles, and hands), rashes, or other allergic reactions.

Tell Your Rheumatology Provider

You should notify your rheumatology provider if you have symptoms of an infection, such as a fever or cough, or if you think you are having any side effects, especially diarrhea or allergic reactions, while taking this medication. If you are allergic to aspirin, other NSAIDs, sulfa drugs, or have nasal polyps (linked to a greater chance of NSAID allergy), let your doctor know.  

Some patients should not take NSAIDs. You should discuss with your rheumatology provider whether it is okay to take NSAIDs if any of the following apply:

  • Known problems with kidneys or liver
  • History of stomach problems (such as reflux or ulcers)
  • Inflammatory bowel disease (Crohn's disease or ulcerative colitis)
  • If you take blood thinners or corticosteroids
  • If you have cardiovascular problems (such as high blood pressure, heart failure, or a past stroke or heart attack)

Make sure to notify your other physicians while you are taking this drug. If you are pregnant, considering pregnancy, or breastfeeding, let your doctor know before starting this medication. There is a chance of getting NSAID-induced unruptured follicle syndrome, that can cause patients to have difficulty conceiving. In those rare cases, if disease control is not be compromised, it would be recommended to stop NSAIDs before conception. There is risk of premature closure of the ductus arteriosus (a blood vessel in the developing fetus) so the use of NSAIDs in the third trimester is discouraged. You should also talk with your doctor before undergoing any surgeries while taking this medication.

Updated February 2022 by the American College of Rheumatology Communications and Marketing Committee.

This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis and treatment of a medical or health condition.

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