Nonsteroidal anti-inflammatory drugs

What are nonsteroidal anti-inflammatory drugs (NSAIDs)?

Nonsteroidal anti-inflammatory agents (usually abbreviated to NSAIDs) are a group of medicines that relieve pain and fever and reduce inflammation.

There are nearly two dozen different NSAIDs available, but they all work in the same way, and that is by blocking a specific group of enzymes called cyclo-oxygenase enzymes, often abbreviated to COX enzymes. These enzymes are responsible for the production of prostaglandins. Prostaglandins are a group of compounds with hormone-like effects that control many different processes such as inflammation, blood flow, and the formation of blood clots.

What are nonsteroidal anti-inflammatory agents used for?

NSAIDs are used to treat mild-to-moderate pain that arises from a wide range of conditions such as headaches, menstruation, migraines, osteoarthritis or rheumatoid arthritis, sprains and strains, and toothache.

Aspirin is a NSAID that is used in small doses to lower the risks of having a heart attack or a stroke caused by a blood clot. It may also be given as a single dose at the time of a heart attack to improve outcomes. This is because it irreversibly inhibits the COX-1 enzyme.

What are the differences between nonsteroidal anti-inflammatory agents?

NSAIDs may be grouped according to their preference for COX-1 and COX-2 enzymes. Those that favor COX-1 are more likely to cause gastrointestinal side effects. Those that favor COX-2 have a higher risk of cardiovascular effects but less gastrointestinal effects. Higher dosages of NSAIDs tend to result in more COX-2 enzyme inhibition (and more cardiovascular side effects), even in those NSAIDs traditionally seen as low risk (such as ibuprofen). NSAIDs with higher activity against COX-2 enzymes should be used with caution in people with cardiovascular disease or at increased risk of cardiovascular disease.

Both types of COX enzymes produce prostaglandins; however, the main function of COX-1 enzymes is to produce baseline levels of prostaglandins that activate platelets and protect the lining of the gastrointestinal tract, whereas COX-2 enzymes are responsible for releasing prostaglandins after infection or injury.

Most NSAIDs inhibit both enzymes to a certain extent.

List of Common NSAIDs

Generic name	Brand names
More COX-1 selective*
flurbiprofen	Ansaid
ketorolac	Only generic
ketoprofen	Oruvail
tolmetin	Generic
aspirin	Ecotrin, Miniprin, and generic
Relatively nonselective
ibuprofen	Advil, Motrin, Genpril
naproxen	Aleve, Flanax Pain Reliever, Naprosyn
Less than 50-fold COX-2 selective*
indomethacin	Indocin, Tivorbex
sulindac	Clinoril
piroxicam	Feldene
mefenamic acid	Ponstel
meloxicam	Mobic
diclofenac	Cataflam, Voltaren, Zipsor, Zorvolex
celecoxib	Celebrex
etodolac	Generic
More than 50-fold COX-2 selective
etoricoxib	Not approved in the U.S.
lumiracoxib	Not approved in the U.S.
rofecoxib	Withdrawn because of safety concerns

*Ranked in order from the least COX-2 activity to the highest within that group.

Note that selectivity rankings vary depending on resources used. This table is based on a best effort accumulation of data.

Are nonsteroidal anti-inflammatory agents safe?

NSAIDs are one of the most widely prescribed group of medicines; however, they are associated with some serious side effects.

NSAIDs can increase your risk of a fatal heart attack or stroke. The risk increases the higher the dosage and the longer the length of time you remain on an NSAID for. People with pre-existing heart disease are more at risk and certain NSAIDs, such as diclofenac and celecoxib, have been linked to more heart-related side effects than others. NSAIDs should never be used just before or after heart bypass surgery (coronary artery bypass graft, or CABG).

Gastrointestinal (GI) side effects are also common, and usually related to dosage and duration of treatment although some NSAIDs, such as ketorolac, aspirin and indomethacin, are associated with a higher risk. Elderly people or those taking other medicines that irritate the stomach are more likely to experience life-threatening GI side effects, such as stomach or intestinal bleeding.

Most NSAIDs are not suitable for children or adolescents under the age of 18 years. Ibuprofen is the only NSAID approved for children aged three months and older. Aspirin can increase the risk of Reye's syndrome if given to children with a viral illness. Never give aspirin to children except on a doctors advice.

Most NSAIDs should not be taken during the last three months of pregnancy or while breastfeeding except on a doctor’s advice.

What are the side effects of nonsteroidal anti-inflammatory agents?

NSAIDs can potentially cause a range of side effects, especially when used at higher than recommended dosages for long periods of time.

Gastrointestinal side effects that may occur include bloating, diarrhea, constipation, irritation of the lining of the stomach, nausea or vomiting.

NSAIDs may also affect kidney function and reduce how quickly blood flows through the kidneys. They may cause retention of sodium and water which can lead to edema and high potassium levels. Occasionally, they may cause more serious damage to the kidneys.

Some NSAIDs, particularly diclofenac and those that are selective for COX-2 enzymes, have a high risk of cardiovascular thrombotic events such as a heart attack or stroke. Other heart-related side effects such as high blood pressure, congestive heart failure, and palpitations have also been reported.

In addition, some people taking NSAIDs have experienced asthma attacks, bleeding, fatigue, headache, insomnia, low neutrophil levels, urticaria (hives), vertigo and seizures. Reye’s syndrome, a life-threatening condition that causes swelling in the liver and brain and is mostly associated with aspirin use in young children has also been reported.

List drug with Nonsteroidal anti-inflammatory drugs

Drug Name
Addaprin Generic name: Ibuprofen
Advil Generic name: Ibuprofen
Advil Migraine Generic name: Ibuprofen
Aflaxen Generic name: Naproxen
A-G Profen Generic name: Ibuprofen
Aleve Generic name: Naproxen
Aleve Arthritis Generic name: Naproxen
Aleve Back and Muscle Pain Generic name: Naproxen
Aleve Easy Open Arthritis Generic name: Naproxen
Aleve Liquid Gels Generic name: Naproxen
Anaprox Generic name: Naproxen
Anaprox-DS Generic name: Naproxen
Anjeso Generic name: Meloxicam
Ansaid Generic name: Flurbiprofen
Arthrotec Generic name: Diclofenac And Misoprostol
Clinoril Generic name: Sulindac
Bufen Generic name: Ibuprofen
Caldolor Generic name: Ibuprofen Injection
Cambia Generic name: Diclofenac
Cataflam Generic name: Diclofenac
Children's Advil Generic name: Ibuprofen
Children's Ibuprofen Berry Generic name: Ibuprofen
Children's Motrin Generic name: Ibuprofen
Daypro Generic name: Oxaprozin
Diclofenac Generic name: Diclofenac
Diclofenac (Intravenous) Generic name: Diclofenac
Diclofenac (Oral) Generic name: Diclofenac
Diclofenac and misoprostol Generic name: Diclofenac And Misoprostol
Duexis Generic name: Famotidine And Ibuprofen
Dyloject Generic name: Diclofenac
EC-Naprosyn Generic name: Naproxen
Esomeprazole and naproxen Generic name: Esomeprazole And Naproxen
Etodolac Generic name: Etodolac
Famotidine and ibuprofen Generic name: Famotidine And Ibuprofen
Feldene Generic name: Piroxicam
Fenoprofen Generic name: Fenoprofen
Flanax Generic name: Naproxen Sodium
Flurbiprofen Generic name: Flurbiprofen
Flurbiprofen (Oral) Generic name: Flurbiprofen
Genpril Generic name: Ibuprofen
Haltran Generic name: Ibuprofen
Ibu Generic name: Ibuprofen
Ibu-2 Generic name: Ibuprofen
Ibu-200 Generic name: Ibuprofen
Ibu-4 Generic name: Ibuprofen
Ibu-6 Generic name: Ibuprofen
Ibu-8 Generic name: Ibuprofen
Ibu-Tab Generic name: Ibuprofen
Ibuprofen Generic name: Ibuprofen
Ibuprofen (Intravenous) Generic name: Ibuprofen
Ibuprofen (Oral) Generic name: Ibuprofen
Ibuprofen and famotidine Generic name: Ibuprofen And Famotidine
Ibuprofen injection Generic name: Ibuprofen Injection
Ibuprofen lysine Generic name: Ibuprofen Lysine
Ibuprohm Generic name: Ibuprofen
Indocin Generic name: Indomethacin
Indocin (Indomethacin Intravenous) Generic name: Indomethacin
Indocin (Indomethacin Oral) Generic name: Indomethacin
Indocin (Indomethacin Rectal) Generic name: Indomethacin
Indocin SR Generic name: Indomethacin
Indomethacin Generic name: Indomethacin
Indomethacin (Intravenous) Generic name: Indomethacin
Indomethacin (Oral) Generic name: Indomethacin
Indomethacin (Rectal) Generic name: Indomethacin
I-Prin Generic name: Ibuprofen
Ketoprofen Generic name: Ketoprofen
Ketorolac nasal Generic name: Ketorolac (nasal)
Ketorolac oral/injection Generic name: Ketorolac (oral/injection)
Lodine Generic name: Etodolac
Lodine XL Generic name: Etodolac
Lofena Generic name: Diclofenac
Meclofenamate Generic name: Meclofenamate
Mefenamic acid Generic name: Mefenamic Acid
Meloxicam Generic name: Meloxicam (oral/injection)
Meloxicam (Intravenous) Generic name: Meloxicam
Meloxicam (Oral) Generic name: Meloxicam
Midol Generic name: Ibuprofen
Midol Extended Relief Generic name: Naproxen
Midol IB Generic name: Ibuprofen
Mobic Generic name: Meloxicam
Motrin Childrens Generic name: Ibuprofen
Motrin IB Generic name: Ibuprofen 200mg
Motrin IB Migraine Generic name: Ibuprofen
Motrin Infant Drops Generic name: Ibuprofen
Motrin Migraine Pain Generic name: Ibuprofen
Nabumetone Generic name: Nabumetone
Nalfon Generic name: Fenoprofen
Nalfon 200 Generic name: Fenoprofen
Naprelan Generic name: Naproxen
Naprelan 500 Generic name: Naproxen
Naprelan Dose Card Generic name: Naproxen
Naprosyn Generic name: Naproxen
Naproxen Generic name: Naproxen
Naproxen and esomeprazole Generic name: Naproxen And Esomeprazole
NeoProfen Generic name: Ibuprofen Injection
Neoprofen (Ibuprofen Intravenous) Generic name: Ibuprofen
Neoprofen (Ibuprofen lysine Intravenous) Generic name: Ibuprofen Lysine
Nuprin Generic name: Ibuprofen
Orudis Generic name: Ketoprofen
Orudis KT Generic name: Ketoprofen
Oruvail Generic name: Ketoprofen
Oxaprozin Generic name: Oxaprozin
Piroxicam Generic name: Piroxicam
Ponstel Generic name: Mefenamic Acid
Prevacid Naprapac Generic name: Lansoprazole And Naproxen
Proprinal Generic name: Ibuprofen
Qmiiz Generic name: Meloxicam
Q-Profen Generic name: Ibuprofen
Relafen Generic name: Nabumetone
Smart Sense Children's Ibuprofen Generic name: Ibuprofen
Sprix Nasal Spray Generic name: Ketorolac (nasal)
Sulindac Generic name: Sulindac
Tivorbex Generic name: Indomethacin
Tolectin 600 Generic name: Tolmetin
Tolectin DS Generic name: Tolmetin
Tolmetin Generic name: Tolmetin
Toradol Generic name: Ketorolac (oral/injection)
Toradol IV/IM Generic name: Ketorolac
Vimovo Generic name: Esomeprazole And Naproxen
Vivlodex Generic name: Meloxicam
Voltaren Generic name: Diclofenac
Voltaren (Diclofenac Oral) Generic name: Diclofenac
Voltaren-XR Generic name: Diclofenac
Wal-Profen Generic name: Ibuprofen
Zipsor Generic name: Diclofenac
Zorvolex Generic name: Diclofenac

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