When your back hurts, head aches, arthritis acts up or you’re feeling feverish, chances are you’ll be reaching for an NSAID (non-steroidal anti-inflammatory drug) for relief.
You take an NSAID every time you consume an aspirin, or an Advil®, or an Aleve®. These drugs are common pain and fever relievers. Every day millions of people choose an NSAID to help them relieve headache, body aches, swelling, stiffness and fever.
You know the most common NSAIDs:
You can get non-prescription strength, over-the-counter NSAIDs in drug stores and supermarkets, where you can also buy less expensive generic (not brand name) aspirin, ibuprofen and naproxen sodium.
Acetaminophen (Tylenol®) is not an NSAID. It’s a pain reliever and fever reducer but doesn’t have anti-inflammatory properties of NSAIDs. However, acetaminophen is sometimes combined with aspirin in over-the-counter products, such as some varieties of Excedrin®.
NSAIDs are used to treat:
They can also be used to reduce fever or relieve minor aches caused by the common cold.
NSAIDs block the production of certain body chemicals that cause inflammation. NSAIDs are good at treating pain caused by slow tissue damage, such as arthritis pain. NSAIDs also work well fighting back pain, menstrual cramps and headaches.
NSAIDs work like corticosteroids (also called steroids), without many of the side effects of steroids. Steroids are man-made drugs that are similar to cortisone, a naturally-occurring hormone. Like cortisone, NSAIDs reduce pain and inflammation that often come with joint and muscle diseases and injuries.
Don’t use an over-the-counter NSAID continuously for more than three days for fever, and 10 days for pain, unless your doctor says it’s okay. Over-the-counter NSAIDs work well in relieving pain, but they’re meant for short-term use.
If your doctor clears you to take NSAIDs for a long period of time, you and your doctor should watch for harmful side effects. If you notice bad side effects your treatment may need to be changed.
That depends on the NSAID and the condition being treated. Some NSAIDs may work within a few hours, while others may take a week or two.
Generally, for acute (sharp sudden pain) muscle injuries, we recommend NSAIDs that work quickly. However, these may need to be taken as often as every four to six hours because of their short action time.
For osteoarthritis and rheumatoid arthritis that need long-term treatment, doctors usually recommend NSAIDs that are taken only once or twice a day. However, it generally takes longer for these drugs to have a therapeutic (healing) effect.
NSAIDs are prescribed in different doses, depending on the condition. These drugs may need to be taken from one to four times a day. Don’t increase the dose without asking your doctor first.
You may be prescribed higher doses of NSAIDs if you have rheumatoid arthritis (RA), for example. RA often causes a significant degree of heat, swelling and redness and stiffness in the joints. Lower doses may be prescribed for osteoarthritis and acute muscle injuries since there is generally less swelling and frequently no warmth or redness in the joints.
No single NSAID is guaranteed to work. You and your doctor may need to try out several types of NSAIDs in order to find the right one for you.
Prescription-strength NSAIDs are often recommended for rheumatologic diseases, including rheumatoid arthritis and moderate-to-severe osteoarthritis. These NSAIDs are also prescribed for moderately painful musculoskeletal conditions such as back pain.
Here are a few examples of prescription NSAIDs. Some NSAIDs are only available as generic formulations (no brand names).
Generic names (no brands)
In planning your treatment, your doctor looks at the effectiveness and the risks of these drugs. Your medical history, physical exam, X-rays, blood tests and presence of other medical conditions all play a part in deciding which NSAIDs will work for you.
After you start your NSAID program meet with your doctor regularly to check for any harmful side effects and, if necessary, make any changes. Blood tests or other tests (including a kidney function test) may need to be done for this part of your treatment.
The Food and Drug Administration requires that the labeling of NSAIDs contain these specific warnings:
These warnings are for non-aspirin NSAIDs:
This warning is for all NSAIDs including aspirin:
NSAIDs may increase the chance of serious stomach and bowel side effects like ulcers and bleeding. These side effects can occur without warning signs. This risk may be greater in people who:
You may have side effects if you take large doses of NSAIDs, or if you take them for a long time. Some side effects are mild and go away, while others are more serious and need medical attention. Unless your doctor tells you to do so, don't take an over-the-counter NSAID with a prescription NSAID, multiple over-the-counter NSAIDs or more than the recommended dose of an NSAID. Doing so could increase your risk of side effects.
The side effects listed below are the most common, but there may be others. Ask your doctor if you have questions about your specific medication.
The most frequently reported side effects of NSAIDs are gastrointestinal (stomach and gut) symptoms, such as:
These gastrointestinal symptoms can generally be prevented by taking the drug with food, milk or antacids (such as Maalox® or Mylanta®).
Call your doctor if these symptoms continue for more than a few days even if you’re taking the NSAID with food, milk or antacid. The NSAID may need to be stopped and changed.
Other side effects of NSAIDs include:
If these symptoms go on for more than a few days, stop taking the NSAID and call your doctor.
If you have any of these side effects, it is important to call your doctor right away:
Head (vision, hearing, etc.):
Possible allergic reactions and other problems
NSAIDs can cause high blood pressure (hypertension) in some people. You may have to stop taking NSAIDs if you notice your blood pressure increases even if you’re taking your blood pressure medications and following your diet. Ask your doctor about this before you start taking NSAIDs.
If you have any of the following conditions or circumstances please check with your doctor before you take NSAIDs:
Heart and bleeding conditions
Allergic and drug interactions
Rarely, an NSAID can cause a generalized allergic reaction known as anaphylactic shock. If this happens, it usually occurs soon after the person starts taking the NSAID. The symptoms of this reaction include:
If any of these symptoms occur, call 9-1-1 or have someone drive you to the nearest emergency room immediately.
Remember, before any medication is prescribed, tell your doctor:
Last reviewed by a Cleveland Clinic medical professional on 01/25/2020.