Prescription anti-inflammatory medications are used to reduce pain, inflammation, and fever in acute and chronic medical conditions. Nonsteroidal anti-inflammatory drugs (NSAIDs) block an enzyme called cyclooxygenase (or COX) used by the body to make prostaglandins.

Nonsteroidal anti-inflammatory drugs can be found as both over-the-counter (OTC) medications and those needing a prescription. Prescription NSAIDs are used for individuals living with arthritis, gout, menstrual cramps, headaches, and aches.

Traditional NSAIDs

Nonsteroidal anti-inflammatory drugs are the most prescribed medications for treating arthritis, gout, and osteoarthritis. They are also used to treat headaches, aches and pains, and menstrual cramps.

NSAIDs work very specifically to help reduce pain and fever. NSAIDs block an enzyme called cyclooxygenase (or COX) used by the body to make prostaglandins, which are hormone-like chemicals in the body that contribute to inflammation, pain, and fever.

Prostaglandins raise the body’s temperature and dilate blood vessels, which can increase swelling and redness. By reducing the production of prostaglandins, NSAIDs can help relieve the discomfort of fever and reduce inflammation and associated pain.

Examples of NSAIDs include:

  • Clinoril (sulindac)
  • Daypro (oxaprozin)
  • Feldene (piroxicam)
  • Indocin (indomethacin)
  • Mobic (meloxicam)
  • Nalfon (fenoprofen)
  • Ocufen (flurbiprofen)
  • Ponstel (mefenamic acid)
  • Toradol (ketorolac)
  • Voltaren (diclofenac)

COX-2 Inhibitors

COX-2 inhibitors are a type of NSAID that selectively blocks the COX-2 enzyme and not the COX-1 enzyme. The goal of COX-2 inhibitors is to reduce pain and inflammation without losing the protection of COX-1 in the gastrointestinal tract. This produces fewer gastrointestinal side effects.

There are two forms of the cyclooxygenase enzyme: COX-1 and COX-2. COX-1 is known to be present in most of the tissues in our bodies, while COX-2 is responsible for inflammation.

In the gastrointestinal tract, COX-1 maintains the normal lining of the stomach and intestines, protecting the stomach from the digestive juices. The enzyme is also involved in kidney and platelet function.

Both COX-1 and COX-2 produce the prostaglandins that contribute to pain, fever, and inflammation, but since COX-1’s primary role is to protect the stomach and intestines and contribute to blood clotting, using drugs that inhibit it can lead to unwanted side effects.

Currently, only one COX-2 inhibitor is available on the market in the United States. Celecoxib (Celebrex) is a popular COX-2 inhibitor used to treat specific diseases such as juvenile rheumatoid arthritis, ankylosing spondylitis, and arthritis.

It’s important to note that Vioxx (rofecoxib) and Bextra (valdecoxib) were withdrawn from the U.S. market in 2004 and 2005, respectively.

Uses

NSAIDs can be used for a variety of issues. NSAIDs should be used at the lowest dose possible for the shortest amount of time, as longer use can increase the potential for long-term complications and worsening side effects.

Some people take NSAIDs on and off for years because of menstrual cramps, but not consistently every single day. Specific dosages and usage should be determined by your healthcare provider, as well as recommended manufacturing guidelines.

NSAIDs are most commonly used for the treatment of the following medical conditions:

  • Pain
  • Inflammation
  • Arthritis
  • Osteoarthritis
  • Migraines
  • Headaches
  • Rheumatoid arthritis
  • Juvenile rheumatoid arthritis
  • Gout
  • Joint pain
  • Ankylosing spondylitis
  • Fibromyalgia
  • Sprains and strains
  • Tendonitis
  • Bursitis
  • Menstrual cramps
  • Cold and flu symptoms

Precautions and Contraindications

Prescription nonsteroidal anti-inflammatory drugs should be used cautiously in a variety of patients. Be aware of these:

  • Do not use NSAIDs or COX-2 inhibitors directly before, during, or after heart surgery (bypass surgery).Patients with a history of cardiovascular disease (e.g., angina, heart attack, TIA, stroke, or congestive heart failure) should be extremely careful using NSAIDs or COX-2 inhibitors.Patients with risk factors for cardiovascular disease (e.g., diabetes, smoking, elevated cholesterol, obesity, or family history) should be very careful using NSAIDs and COX-2 inhibitors.NSAIDs are not recommended for use between 20 to 30 weeks of pregnancy and should be avoided altogether after 30 weeks of pregnancy.

Celebrex

These contraindications and precautions pertain to Celebrex (celecoxib):

  • It is contraindicated in patients with known hypersensitivity to celecoxib.It should not be given to patients who have demonstrated allergic-type reactions to sulfonamides.It should not be given to patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs.It is contraindicated for treating perioperative pain in the setting of coronary artery bypass graft (CABG) surgery.

Side Effects

As with all medications, there are possible side effects you may experience while taking NSAIDs. Common and less severe side effects include:

  • Stomach pain
  • Heartburn
  • Nausea
  • Vomiting
  • Abdominal discomfort
  • Constipation
  • Diarrhea
  • Dizziness
  • Stomach ulcers
  • Bleeding
  • High blood pressure
  • Kidney damage
  • Increased risk of bruising due to decreased clotting time
  • Heart attack
  • Stroke
  • Heart failure

When to Call Your Healthcare Provider

If you feel you are experiencing a serious side effect, get prompt medical attention. If you are experiencing life-threatening symptoms, call 911 immediately.

Black Box Warning

The Food and Drug Administration (FDA) has continued to issue a black box warning to the general public saying that prescription NSAIDs can increase the chance of heart attack and/or stroke, which can ultimately lead to death.

Specific side effects that may warrant contacting your healthcare provider include:

  • Shortness of breathConfusionFast heartbeatDouble visionLoss of bladder control

It is also important to note that individuals can have a severe allergic reaction, otherwise known as anaphylaxis, as a result of taking NSAIDs. Individuals suffering from an allergic reaction to an NSAID may experience the following symptoms: hives, difficulty breathing including wheezing, and swelling of the face, lips, tongue, and/or throat.

Warnings and Interactions

NSAIDs should be taken exactly as prescribed and should only be used how they are intended.

In general, using NSAIDs occasionally (rather than every day) and at the lowest dose possible reduces your chances of developing serious side effects. If you’re concerned or unsure about your risk of side effects with NSAIDs, talk to your healthcare provider

or pharmacist.

As previously mentioned, NSAIDs may increase the chance of stomach and bowel side effects like ulcers and bleeding, which occur without warning signs. This risk may be greater in people who:

  • Are olderHave previous history of stomach ulcers or bleeding problemsAre on blood thinnersAre on multiple prescription or over-the-counter NSAIDsDrink three or more alcoholic beverages per day

While it is possible to take multiple NSAIDs at the same time, it is highly advised not to. If you are taking more than one NSAID, consult with your prescribing healthcare provider to see if there are other medication options available.

Indocin

Indocin (indomethacin) comes with a black box warning for potential stomach bleeding and increased heart risk. A black box warning is the strongest warning level issued by the FDA, alerting patients and healthcare providers of any serious risks associated with taking the medication.

All NSAIDs, including indomethacin, run a risk of creating problems in the stomach, specifically with an increased risk of bleeding or developing an ulcer. In some cases, these side effects can be fatal.

A Word From Verywell

Prescription anti-inflammatory medications are extremely helpful analgesics that can help reduce pain and inflammation. NSAIDs can be effective for a wide variety of orthopedic conditions from arthritis, tendinitis, rheumatoid arthritis, and sprains and strains.

There are possible side effects with increased dosage and usage of NSAIDs, but having discussions with your healthcare provider can decrease the risks.