Table of ContentsView AllTable of ContentsHow They WorkCOX-2 InhibitorsUsesPrescriptionsPrecautionsSide EffectsWarningsWhen to Call a Provider
Table of ContentsView All
View All
Table of Contents
How They Work
COX-2 Inhibitors
Uses
Prescriptions
Precautions
Side Effects
Warnings
When to Call a Provider
Prescription anti-inflammatory medications are used to reduce pain, inflammation, and fever in acute and chronic medical conditions. They are also called nonsteroidal anti-inflammatory drugs (NSAIDs).
This article discusses prescription anti-inflammatory medications, what they are, and why your healthcare provider might prescribe them. It also explains side effects and interactions.
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How Do NSAIDs Work?
Nonsteroidal anti-inflammatory drugs are the most prescribed medications for treating arthritis and gout. They are also used to treat headaches, aches and pains, and menstrual cramps.
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.
NSAID Alternatives
People who are unable to tolerate the side effects of NSAIDs may need to try alternative drugs. Some of these include:
What Are COX-2 Inhibitors?
There are two forms of the cyclooxygenase enzyme: COX-1 and COX-2. Both COX-1 and COX-2 produce prostaglandins that contribute to pain, fever, and inflammation.
COX-1 also helps maintain the normal lining of the stomach and intestines, protecting the stomach from digestive juices. It is involved in kidney and platelet function as well.Because of these additional roles, drugs that inhibit COX-1 can cause unwanted side effects.
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.
Over-the-Counter NSAIDs
NSAIDs are available over the counter (OTC) for treating minor to moderate pain, such as arthritis pain, menstrual cramps, and other aches and pains. OTC NSAIDs include:
Over-the-counter NSAIDs inhibit both COX-1 and COX-2, but some, like aspirin and Aleve, are more selective for COX-1. Advil is considered non-selective.
Prescription NSAIDs
Prescription NSAIDs can be either more selective for COX-1, nonselective, or selective for COX-2. Examples of prescription NSAIDs include:
Examples of prescription NSAIDs that are more selective for COX-1 include Ocufen and Feldene. Fenoprofen calcium is an example of an NSAID that is non-selective.
Currently, only one COX-2 inhibitor is available in the United States. Celebrex (celecoxib) is used to treat specific diseases such as juvenile rheumatoid arthritis,ankylosing spondylitis, and arthritis.
What Are NSAIDs Used For?
NSAIDs can be used for a variety of issues. They 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.
NSAIDs are most commonly used for the treatment of the following medical conditions:
How Long Do NSAIDs Take to Work?NSAIDs vary in how long they take to start working. Some people will experience relief within a few hours after taking the first dose. Others may not notice the effects for a week or two.If an NSAID doesn’t seem to be effective after the first two weeks of use, talk to your healthcare provider. You may need to try a different medication.
How Long Do NSAIDs Take to Work?
NSAIDs vary in how long they take to start working. Some people will experience relief within a few hours after taking the first dose. Others may not notice the effects for a week or two.If an NSAID doesn’t seem to be effective after the first two weeks of use, talk to your healthcare provider. You may need to try a different medication.
NSAIDs vary in how long they take to start working. Some people will experience relief within a few hours after taking the first dose. Others may not notice the effects for a week or two.
If an NSAID doesn’t seem to be effective after the first two weeks of use, talk to your healthcare provider. You may need to try a different medication.
How Are NSAIDs Prescribed?
Prescription NSAIDs are generally reserved for people experiencing moderate to severe pain or who have conditions that cause chronic pain, such as arthritis, gout, and painful menstrual periods.
When Are Stronger NSAIDs Prescribed?You may need a stronger NSAID if your pain is severe and it is not responding to your current medication, or if your current medication only provides partial relief and/or wears off between doses.
When Are Stronger NSAIDs Prescribed?
You may need a stronger NSAID if your pain is severe and it is not responding to your current medication, or if your current medication only provides partial relief and/or wears off between doses.
Who Should Not Take NSAIDs?
Prescription nonsteroidal anti-inflammatory drugs should be used cautiously in a variety of patients. Be aware of these situations:
Celebrex
These contraindications and precautions pertain to Celebrex (celecoxib):
What Are the Side Effects?
As with all medications, there are possible side effects you may experience while taking NSAIDs. Common side effects include:
Less common/severe side effects may include:
Boxed WarningThe Food and Drug Administration (FDA) has continued to issue a boxed 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.Generally, these serious side effects occur during the first few weeks of taking an NSAID, and the risk continues to increase the longer individuals take NSAIDs.
Boxed Warning
The Food and Drug Administration (FDA) has continued to issue a boxed 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.Generally, these serious side effects occur during the first few weeks of taking an NSAID, and the risk continues to increase the longer individuals take NSAIDs.
The Food and Drug Administration (FDA) has continued to issue a boxed 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.
Generally, these serious side effects occur during the first few weeks of taking an NSAID, and the risk continues to increase the longer individuals take NSAIDs.
Warnings and Interactions
NSAIDs should be taken exactly as prescribed and should only be used in the way 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.
Stomach and bowel side effects like ulcers and bleeding can occur without warning signs. This risk may be greater in people who:
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
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.
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.
Specific side effects that may warrant contacting your healthcare provider include:
It is also important to note that individuals can have a severe allergic reaction, otherwise known asanaphylaxis, 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.
Summary
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 including arthritis, tendinitis, rheumatoid arthritis, and sprains and strains.
There are possible side effects with increased dosage and usage of NSAIDs; consult with your healthcare provider to discuss decreasing the risks.
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Arthritis Foundation.NSAIDs.Drożdżal S, Lechowicz K, Szostak B, et al.Kidney damage from nonsteroidal anti-inflammatory drugs-Myth or truth? Review of selected literature.Pharmacol Res Perspect. 2021;9(4):e00817. doi:10.1002/prp2.817Yang M, Wang HT, Zhao M, et al.Network meta-analysis comparing relatively selective COX-2 inhibitors versus coxibs for the prevention of NSAID-induced gastrointestinal injury.Medicine (Baltimore). 2015;94(40):e1592. doi:10.1097/MD.0000000000001592Timpe Behnen EM.Which NSAIDs are most selective for COX-1 and COX-2?Pract Pain Manag. 2013;13(7).Bello AE, Holt RJ.Cardiovascular risk with non-steroidal anti-inflammatory drugs: clinical implications.Drug Safety.2014;37,11:897-902. doi:10.1007/s40264-014-0207-2Ruschitzka F, Borer JS, Krum H, et al.Differential blood pressure effects of ibuprofen, naproxen, and celecoxib in patients with arthritis: the PRECISION-ABPM (Prospective Randomized Evaluation of Celecoxib Integrated Safety Versus Ibuprofen or Naproxen Ambulatory Blood Pressure Measurement) Trial.Eur Heart J. 2017;38(44):3282-3292. doi: 10.1093/eurheartj/ehx508Food and Drug Administration.Nonsteroidal anti-inflammatory drugs (NSAIDs): drug safety communication - avoid use of NSAIDs in pregnancy at 20 weeks or later.Solomon DH.Patient education: Nonsteroidal antiinflammatory drugs (NSAIDs) (Beyond the Basics). UpToDate.MedlinePlus.Celecoxib.Food and Drug Administration.Highlights of prescribing information for Indocin.
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Arthritis Foundation.NSAIDs.Drożdżal S, Lechowicz K, Szostak B, et al.Kidney damage from nonsteroidal anti-inflammatory drugs-Myth or truth? Review of selected literature.Pharmacol Res Perspect. 2021;9(4):e00817. doi:10.1002/prp2.817Yang M, Wang HT, Zhao M, et al.Network meta-analysis comparing relatively selective COX-2 inhibitors versus coxibs for the prevention of NSAID-induced gastrointestinal injury.Medicine (Baltimore). 2015;94(40):e1592. doi:10.1097/MD.0000000000001592Timpe Behnen EM.Which NSAIDs are most selective for COX-1 and COX-2?Pract Pain Manag. 2013;13(7).Bello AE, Holt RJ.Cardiovascular risk with non-steroidal anti-inflammatory drugs: clinical implications.Drug Safety.2014;37,11:897-902. doi:10.1007/s40264-014-0207-2Ruschitzka F, Borer JS, Krum H, et al.Differential blood pressure effects of ibuprofen, naproxen, and celecoxib in patients with arthritis: the PRECISION-ABPM (Prospective Randomized Evaluation of Celecoxib Integrated Safety Versus Ibuprofen or Naproxen Ambulatory Blood Pressure Measurement) Trial.Eur Heart J. 2017;38(44):3282-3292. doi: 10.1093/eurheartj/ehx508Food and Drug Administration.Nonsteroidal anti-inflammatory drugs (NSAIDs): drug safety communication - avoid use of NSAIDs in pregnancy at 20 weeks or later.Solomon DH.Patient education: Nonsteroidal antiinflammatory drugs (NSAIDs) (Beyond the Basics). UpToDate.MedlinePlus.Celecoxib.Food and Drug Administration.Highlights of prescribing information for Indocin.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Arthritis Foundation.NSAIDs.Drożdżal S, Lechowicz K, Szostak B, et al.Kidney damage from nonsteroidal anti-inflammatory drugs-Myth or truth? Review of selected literature.Pharmacol Res Perspect. 2021;9(4):e00817. doi:10.1002/prp2.817Yang M, Wang HT, Zhao M, et al.Network meta-analysis comparing relatively selective COX-2 inhibitors versus coxibs for the prevention of NSAID-induced gastrointestinal injury.Medicine (Baltimore). 2015;94(40):e1592. doi:10.1097/MD.0000000000001592Timpe Behnen EM.Which NSAIDs are most selective for COX-1 and COX-2?Pract Pain Manag. 2013;13(7).Bello AE, Holt RJ.Cardiovascular risk with non-steroidal anti-inflammatory drugs: clinical implications.Drug Safety.2014;37,11:897-902. doi:10.1007/s40264-014-0207-2Ruschitzka F, Borer JS, Krum H, et al.Differential blood pressure effects of ibuprofen, naproxen, and celecoxib in patients with arthritis: the PRECISION-ABPM (Prospective Randomized Evaluation of Celecoxib Integrated Safety Versus Ibuprofen or Naproxen Ambulatory Blood Pressure Measurement) Trial.Eur Heart J. 2017;38(44):3282-3292. doi: 10.1093/eurheartj/ehx508Food and Drug Administration.Nonsteroidal anti-inflammatory drugs (NSAIDs): drug safety communication - avoid use of NSAIDs in pregnancy at 20 weeks or later.Solomon DH.Patient education: Nonsteroidal antiinflammatory drugs (NSAIDs) (Beyond the Basics). UpToDate.MedlinePlus.Celecoxib.Food and Drug Administration.Highlights of prescribing information for Indocin.
Arthritis Foundation.NSAIDs.
Drożdżal S, Lechowicz K, Szostak B, et al.Kidney damage from nonsteroidal anti-inflammatory drugs-Myth or truth? Review of selected literature.Pharmacol Res Perspect. 2021;9(4):e00817. doi:10.1002/prp2.817
Yang M, Wang HT, Zhao M, et al.Network meta-analysis comparing relatively selective COX-2 inhibitors versus coxibs for the prevention of NSAID-induced gastrointestinal injury.Medicine (Baltimore). 2015;94(40):e1592. doi:10.1097/MD.0000000000001592
Timpe Behnen EM.Which NSAIDs are most selective for COX-1 and COX-2?Pract Pain Manag. 2013;13(7).
Bello AE, Holt RJ.Cardiovascular risk with non-steroidal anti-inflammatory drugs: clinical implications.Drug Safety.2014;37,11:897-902. doi:10.1007/s40264-014-0207-2
Ruschitzka F, Borer JS, Krum H, et al.Differential blood pressure effects of ibuprofen, naproxen, and celecoxib in patients with arthritis: the PRECISION-ABPM (Prospective Randomized Evaluation of Celecoxib Integrated Safety Versus Ibuprofen or Naproxen Ambulatory Blood Pressure Measurement) Trial.Eur Heart J. 2017;38(44):3282-3292. doi: 10.1093/eurheartj/ehx508
Food and Drug Administration.Nonsteroidal anti-inflammatory drugs (NSAIDs): drug safety communication - avoid use of NSAIDs in pregnancy at 20 weeks or later.
Solomon DH.Patient education: Nonsteroidal antiinflammatory drugs (NSAIDs) (Beyond the Basics). UpToDate.
MedlinePlus.Celecoxib.
Food and Drug Administration.Highlights of prescribing information for Indocin.
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