Drug Class Guide
NSAIDs (Nonsteroidal Anti-Inflammatory Drugs)
Everyday pain relievers that also reduce inflammation and fever, with real risks for the stomach, kidneys and heart when used often.
How NSAIDs Work
NSAIDs block COX enzymes that make prostaglandins, chemicals that drive pain, swelling and fever. Prostaglandins also protect the stomach lining and support blood flow to the kidneys, which explains most NSAID side effects. Celecoxib targets mainly COX-2, so it is gentler on the stomach.
What NSAIDs Treat
- Osteoarthritis
- Rheumatoid arthritis
- Back pain
- Headaches and migraine
- Menstrual cramps, sprains and fever
NSAIDs in Our Medication Guide
- IbuprofenAdvil, MotrinOver the counter and by prescription; short-acting.
- NaproxenAleve, NaprosynLonger-acting, usually taken twice daily.
- MeloxicamMobicPrescription; taken once daily.
- DiclofenacVoltaren, Cambia, ZipsorPills and a topical gel; the gel has much less effect on the rest of the body.
- CelecoxibCelebrexCOX-2 selective, so fewer stomach ulcers; carries the same heart warning.
- Esomeprazole-NaproxenVimovoNaproxen combined with a stomach-protecting PPI.
Common Side Effects
Stomach upset and heartburn are common. More serious risks, which rise with dose, duration and age, include stomach ulcers and bleeding, kidney injury, fluid retention and higher blood pressure.
Important Cautions
- Prescription NSAIDs carry FDA boxed warnings for heart attack, stroke and serious stomach bleeding.
- Avoid them with kidney disease, heart failure, a past ulcer, or while taking a blood thinner, unless your doctor approves.
- Avoid them from 20 weeks of pregnancy onward unless a doctor advises otherwise.
- Do not combine two NSAIDs, such as ibuprofen and naproxen.
Common Questions About NSAIDs
Which NSAID is easiest on the stomach?
Celecoxib causes fewer ulcers than older NSAIDs, and topical diclofenac gel puts far less drug into the bloodstream. Taking an NSAID with food helps with upset stomach but does not prevent ulcers; for people at high risk, a PPI is sometimes added.
Can I take NSAIDs with blood pressure medicine?
Regular use can raise blood pressure and weaken the effect of ACE inhibitors, ARBs and diuretics. The combination of an NSAID with both an ACE inhibitor or ARB and a diuretic can injure the kidneys. Ask us before using NSAIDs for more than a few days.
Is acetaminophen an NSAID?
No. Acetaminophen (Tylenol) relieves pain and fever but does not reduce inflammation, and it does not cause stomach bleeding or raise blood pressure the way NSAIDs do. Its main risk is liver damage at high doses or with heavy alcohol use.
This guide is general information, not a substitute for advice about your own medicines. Do not start, stop or switch a medication without talking with your doctor. Questions about a prescription? Our internal medicine team can help.
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Trusted Resources for NSAIDs
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