Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Strength and Uses

Both OTC and prescribed NSAIDs help to reduce pain and swelling

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used in different strengths for treating a variety of common conditions, like arthritis, tendonitis, and bursitis. These different NSAIDs are useful because they help decrease pain, control fever, and reduce inflammation.

Anti-inflammatory medicines fight pain and unwanted or abnormal immune system reactions by reducing inflammation. They also come with some side effects, especially for people who have underlying risk factors, such as stomach ulcers or high blood pressure.

This article discusses the pros and cons of prescription and over-the-counter (OTC) NSAIDs. It discusses some of the safe alternatives to using these anti-inflammatory drugs.

What Does Anti-Inflammatory Mean?

The term "anti-inflammatory" refers to the ability of a medicine to help fight pain and unwanted or abnormal immune system reactions by reducing inflammation.

An illustration with what to know about non-steroidal anti-inflammatory drugs (NSAIDs)

Illustration by Danie Drankwalter for Verywell Health

Prescription vs. OTC NSAIDs

NSAIDs are available in both over-the-counter (OTC) and prescription formulations. Much of the difference among NSAID drugs lies in how they target the two forms of the cyclooxygenase enzyme, called COX-1 and COX-2.

COX-1 is most active in tissues including those that protect the digestive tract, while COX-2 plays a key anti-inflammatory role (reducing pain and fever) in the body. The NSAID drugs have been developed across a spectrum that makes them selective (act on receptors for) COX-1 or COX-2. Some drugs, like Advil, are considered non-selective.

COX-2 inhibitors may be an option for people who have gastrointestinal side effects, which are common with OTC NSAIDs. The prescription-only COX-2 inhibitor Celebrex (celecoxib) was developed to provide pain relief without causing digestive or bleeding risks.

Celebrex remains the only prescription option in the United States for people seeking a selective COX-2 inhibitor.

Common Prescription NSAIDs

Some of the OTC anti-inflammatories are also available in stronger, prescription formulations. In some cases, they are longer-acting drugs. Stronger NSAIDs available by prescription include:

Common OTC NSAIDs

There are several NSAIDs sold over the counter under different brand names and as a generic:

Many people experience adequate symptom relief with OTC NSAIDs and do not need to take stronger, prescription-strength options. While both OTC and prescription NSAIDs help relieve pain, prescription NSAIDs are more likely to reduce inflammation. Sometimes prescription NSAIDs are used for long-lasting relief.

Is Tylenol an NSAID?

Tylenol (acetaminophen) is not an NSAID. While it has analgesic (pain-relieving) and antipyretic (fever-reducing) properties like NSAIDs, it doesn't reduce inflammation or coagulation (blood clotting). This is because Tylenol only acts on the central nervous system, while NSAIDs act systemically, affecting both the central nervous system and the body as a whole.

Which NSAID Is Best?

Usually, different NSAIDs can have similar effects. For example, if you are experiencing discomfort from arthritis, you might get relief from either Aleve (naproxen) or Advil (ibuprofen). But sometimes, people have a different response to treatment with a different medication, and a few medications might help your symptoms, while others do not have a significant effect.

It's difficult to predict which medications will be the most beneficial. The best way to determine which NSAID is best for you is to try different options. Often a healthcare provider will recommend one NSAID, and if symptoms don't improve within several weeks of treatment, another NSAID can be tried.

One of the best reasons to consider some of the COX-2 inhibitors, such as Celebrex or Mobic, is that these may be taken as once-a-day doses rather than three or four times daily. In addition, the COX-2 inhibitors are thought to have fewer side effects on the stomach.

Is Ibuprofen or Naproxen Better for Inflammation?

There isn't much research comparing ibuprofen and naproxen. Ibuprofen typically will provide pain relief faster. Both drugs are similar in strength once they start working, and they have similar side effects, though Naproxen's effects can be expected to last longer. Keep in mind that you should not take both at the same time.

Additional Treatment Options for Inflammation

Medicine isn't the only way to control inflammation and discomfort. Due to the possible side effects of medication, many healthcare providers recommend other methods to control inflammation, especially chronic inflammation.

Some have better scientific support than others, but almost all are safe to try. Among them is the R.I.C.E. protocol, which stands for:

  • Rest
  • Ice
  • Compression
  • Elevation

Other treatments that may be helpful include certain foods and supplements associated with the anti-inflammatory diet. Topical treatments and physical activities or therapy also may help.

An often-neglected method to control inflammation is rest. Getting enough overall rest and sleep as well as taking it easy on the injured part of your body allows the inflammation to subside and the recovery process to unfold.

Keep in mind that some options, like physical therapy, can be done in combination with medications.

Side Effects of NSAIDs

Side Effects of Nonsteroidal Anti-Inflammatory Medications

Illustration by Jessica Olah for Verywell Health

NSAID medications have potential side effects, even those that can be obtained over the counter. Some of the side effects are minor, and others are potentially dangerous.

Some people may be more prone to side effects. However, it is important to understand that even for healthy people without underlying medical conditions, there is an associated risk. The benefits of taking an anti-inflammatory medication need to be balanced with the possible risks of taking the medication.

Anyone taking NSAID medications for more than a few days should have a discussion with their healthcare provider about the potential for side effects.

Some of the more common side effects of NSAID medications include:

  • Stomach upset/ulcers: Some people are prone to gastrointestinal upset and stomach ulcers as a result of taking these medications. People with a history of stomach ulcers need to use extreme caution with NSAIDs, and always under the supervision of their healthcare provider.
  • Hypertension/stroke: The use of NSAID medications, especially for routine, longer-term use, has been shown to increase the risk of hypertension and stroke. Even low-dose aspirin is no longer recommended to prevent stroke, as its risks may outweigh the benefits.
  • Bleeding risk: Certain NSAID medications can cause an increased risk of bleeding. This is particularly true for aspirin. Most people can tolerate this, but people who have upcoming surgical procedures or are on other blood-thinning medications may not be able to take NSAIDs.
  • Kidney problems: People with underlying kidney conditions (like chronic kidney disease) may not be able to take NSAID medications, even in very low doses for a short time.
  • Heart disease: The COX-2 inhibitors have an FDA boxed warning regarding an increased risk of heart attack. NSAIDs should not be used in the setting of prior heart disease, especially if you have had a coronary artery bypass graft (CABG). If NSAIDs must be used in high-risk people, naproxen or celecoxib are preferred.

These are not the only risks associated with NSAIDs, but they are the most common. It is always safest to discuss any concerns with your healthcare provider and ask about the risk of taking these medications.

Summary

Nonsteroidal anti-inflammatory drugs (NSAIDs) are available in various strengths and for different purposes. Common over-the-counter medications are used to relieve pain and reduce swelling, often during a temporary illness or injury.

Prescription NSAIDs may be used when stronger or long-acting medications are needed, often to treat chronic pain. Their interaction with forms of the cyclooxygenase enzyme (COX) is a factor in safety and efficacy, as are a person's specific health history and other treatments for any underlying conditions.

Talk to your healthcare provider about NSAID use, even when considering an OTC product, if you think a health condition like heart disease may put you at risk.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.