How to Choose an Effective NSAID (2022)

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

However, anti-inflammatory medicines also come with some side effects, especially for people who have underlying risk factors. This article discusses the pros and cons of prescription and over-the-counter NSAIDs and alternatives to anti-inflammatory drugs.

What Does Anti-Inflammatory Mean?

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

Prescription vs. OTC NSAIDs

NSAIDs are available in both over-the-counter (OTC) and prescription formulations. Some of the OTC anti-inflammatories are also available in stronger, prescription formulations. A class of NSAIDs called COX-2 inhibitors is available by prescription only.

While both OTC and prescription NSAIDs help relieve pain, prescription NSAIDs are more likely to reduce inflammation.

Many people experience adequate symptom relief with OTC NSAIDs and do not need to take stronger, prescription-strength options. Sometimes prescription NSAIDs are used because they provide longer-lasting relief. COX-2 inhibitors may be an option for people who have gastrointestinal side effects, which are common with OTC NSAIDs.

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.

Keep in mind that you should not use more than one NSAID at a time unless your provider specifically tells you to combine them.

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.

(Video) Introduction to Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Most Common NSAIDs

Healthcare professionals often use generic and brand names interchangeably, especially when recommending or prescribing NSAIDs.

The most commonly prescribed or recommended NSAID medications are:

  • Bayer, Ecotrin, Bufferin (aspirin)
  • Motrin, Advil (ibuprofen)
  • Aleve, Naprosyn (naproxen)
  • Mobic (meloxicam)
  • Celebrex (celecoxib)
  • Indocin (indomethacin)

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 patients and healthcare providers are interested in non-pharmacologic methods to control inflammation, especially chronic inflammation.

There are many ways to manage inflammation. Some have better scientific support than others, but almost all are safe to try.

A good place to start is with the R.I.C.E. treatment, which stands for:

  • Rest
  • Ice
  • Compression
  • Elevation

Other treatments that may be helpful include certain foods and supplements, topical treatments, and physical activities.

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.

Not only does this mean resting from athletics, but often this means allowing an injured body part to rest from normal activities that may prolong inflammation. If you have a busy life, rest might not be built into your routine, but ignoring the signs of inflammation may prolong the problem.

Side Effects of NSAIDs

How to Choose an Effective NSAID (1)

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.

(Video) The Best Type of NSAIDs (Non-Steroidal Anti-Inflammatories)

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.
  • 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 NSAID medication and will usually be advised to stop taking them for a specified amount of time prior to having the procedure.
  • Kidney problems:People with underlying kidney conditions may not be able to take NSAID medications, even in very low doses for a shorttime.
  • Heart disease: The COX-2 inhibitors have an FDA black box 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).

These are not the only risks associated with NSAIDs, but they are the most common. It is always safest to have a discussion with your healthcare provider if you have any concerns about the risk of taking these medications.

A Word From Verywell

Nonsteroidal anti-inflammatory medications are commonly used for managing symptoms of musculoskeletal conditions. NSAIDs can be effective for a wide variety of conditions like arthritis, tendinitis, or other inflammatory conditions.

Determining the best anti-inflammatory drug for your condition may depend on a number of different factors, and what works well for one individual may not be the best medication for another. There are possible side effects of different NSAID medications you should be aware of, and you should check with your healthcare provider if you're taking these medications for more than a short period of time.

Frequently Asked Questions

  • Is ibuprofen or naproxen better for inflammation?

    There isn't much head-to-head research comparing the two. One older study found that both were effective for relieving the symptoms of knee arthritis, but naproxen helped with more symptoms, such as night pain. In general, ibuprofen takes effect and wears off more quickly, while naproxen has a slower onset but lasts longer.

    (Video) ANTI-INFLAMMATORY FOODS | what I eat every week
  • Can I take ibuprofen and naproxen together?

    No. Ibuprofen and naproxen are both NSAIDs. Taking more than one NSAID at a time is not recommended because it can increase the risk of adverse effects like stomach issues and bleeding.

  • What is the strongest anti-inflammatory medication?

    Research shows diclofenac is the strongest and most effective non-steroidal anti-inflammatory medicine available. Diclofenec is sold under the prescription brand names Cambia, Cataflam, Zipsor, and Zorvolex. It is also available as a topical gel, Voltaren, which is available over the counter.

    Learn More:Voltaren (diclofenac) versus Advil (ibuprofen)

  • What are the signs of inflammation?

    (Video) NSAID-Non steroidal anti inflammatory drugs (Part-01)= Introduction and Classification (HINDI)

    Inflammation is the body’s immune response to an injury or illness. Acute inflammation causes redness, swelling, heat, pain, and loss of function in the area that is inflamed.

    Learn More:The 5 Classic Signs of Inflammation

  • How can I reduce inflammation quickly?

    Follow the RICE formula for managing inflammation due to an acute injury—rest, ice, compression, and elevation. For systemic inflammation, following an anti-inflammatory diet can help in the long term.

    NSAIDs and corticosteroids are often recommended for fast relief of pain and inflammation.

FAQs

Which NSAIDs are most effective? ›

Research shows diclofenac is the strongest and most effective non-steroidal anti-inflammatory medicine available. 10 Diclofenec is sold under the prescription brand names Cambia, Cataflam, Zipsor, and Zorvolex. It is also available as a topical gel, Voltaren, which is available over the counter.

Do all NSAIDs have the same efficacy? ›

Moreover, individual NSAIDs do differ in their analgesic efficacy. As a group, NSAIDs are excellent analgesics and are even more efficacious than intramuscular morphine for acute pain. However, it should be noted that the evidence for the efficacy of NSAIDs comes mainly from the study of acute pain conditions.

Do different NSAIDs work differently? ›

Many NSAIDs work similarly to each other, but some people have a better response to one kind of NSAID than another. Two people can take identical NSAID drugs and doses and have very different responses. You may need to try one drug for a few weeks, then switch to a different one to find the best NSAID for you.

What are the 3 classes of NSAIDs? ›

Enolic acid (Oxicam) derivatives. Anthranilic acid derivatives (Fenamates) Selective COX-2 inhibitors.

Which NSAID has the least anti-inflammatory efficacy? ›

The most prominent members of this group of drugs, are aspirin, ibuprofen, naproxen, that are all available over the counter in most countries. Paracetamol (acetaminophen) is generally not considered an NSAID because it has only little anti-inflammatory activity.

Which is better for inflammation ibuprofen or naproxen? ›

Ibuprofen and naproxen are so similar that overall, there's not one that is better than the other for adults. Adults and adolescents ages 12 and older might consider ibuprofen or naproxen for different types of pain and inflammation, including: Fever. Muscle or joint pain.

What is the difference between different NSAIDs? ›

Are there any differences between NSAIDs? NSAIDs differ in potency and duration of action. They also differ in their tendency to cause ulcers and bleeding because they differ in their relative inhibition of COX-1 and COX-2.

What's the difference between naproxen and diclofenac? ›

Diclofenac Sodium is available in its generic version but Naproxen is branded and sold under the name 'Aleve'. Overall, Naproxen is a better NSAID for common conditions whereas Diclofenac can be considered as a medication that works very well for gout or osteoarthritis.

Which NSAID is safest? ›

Experts say that taking NSAIDs for a short time at the lowest effective dose is generally safe.
...
This class of medications includes:
  • Aspirin (full dose)
  • Celecoxib (used in Celebrex)
  • Diclofenac (used in Votaren)
  • Ibuprofen (used in Advil or Motrin)
  • Naproxen (used in Aleve)
Nov 19, 2021

Which is safer meloxicam or naproxen? ›

Meloxicam was better tolerated in the gastrointestinal (GI) tract, with fewer GI adverse events in the meloxicam-treated group (30.3%) than in the naproxen-treated group (44.7%), where two patients developed ulcers. No ulcers were seen in meloxicam patients.

Which is better diclofenac or Celebrex? ›

The authors conclude that celecoxib exhibits anti-inflammatory and analgesic activity comparable to that of diclofenac, but results in significantly better GI tolerability and safety.

Is naproxen safer than ibuprofen? ›

Since ibuprofen and naproxen are both NSAIDs, they have the same side effects. However, the risk of heart and blood pressure-related side effects is greater with ibuprofen.

Which NSAID is least harmful to the stomach? ›

Studies have found that ibuprofen and meloxicam may be less likely to bother your stomach, while ketorolac, aspirin, and indomethacin are associated with a higher risk of GI problems.

Which NSAID is least likely to cause bleeding? ›

Selective NSAIDs are sometimes recommended for people who have had a peptic ulcer, gastrointestinal bleeding, or gastrointestinal upset when taking nonselective NSAIDs. Selective NSAIDs have less potential to cause ulcers or gastrointestinal bleeding.

Which NSAID has least effect on blood pressure? ›

Naproxen (Naprosyn) does not increase the risk of hypertension or stroke. Celecoxib (Celebrex) does not increase the risk of hypertension or stroke.

What are the 3 clinically important properties of NSAIDs? ›

NSAIDs are a large group of drugs commonly used to treat arthritis because of their: analgesic (pain-killing) properties. anti-inflammatory properties. antipyretic (fever-reducing) properties.

Are all NSAIDs the same? ›

Do They All Work the Same Way? They all reduce pain and inflammation, but you might find that you get more relief from one NSAID over another, and some NSAIDs may have fewer side effects than others. The effect differs from person to person.

What can I take instead of ibuprofen for inflammation? ›

Naproxen and aspirin are two other common over-the-counter pain relievers. Reeder describes the uses, benefits and potential problems with these as well: Naproxen. Another anti-inflammatory drug, which works much like ibuprofen.

Which is stronger Aleve or ibuprofen? ›

Effectiveness of Aleve and ibuprofen

This makes them effective at relieving pain and reducing inflammation, but there is a risk of stomach-related side effects. As far as effectiveness goes, 440mg Aleve is approximately equivalent to a 400mg ibuprofen.

What should I avoid when taking naproxen? ›

Do not take naproxen with ibuprofen or other non-steroidal anti-inflammatory drugs (NSAIDs). But it's OK to take naproxen with paracetamol or co-codamol that you buy over the counter.

What is a good substitute for naproxen? ›

The main alternative for pain relief is paracetamol, which is available over the counter and is safe for most people to take.

Which NSAIDs have the least side effects? ›

Ibuprofen ranked the lowest in terms of GI risk in nearly every study and had the lowest overall relative risk.

What is considered long term NSAID use? ›

Recommendations for long-term NSAID use

NSAID use is defined as chronic if these medications are taken more than three times a week for more than three months.

Is Tramadol an NSAID? ›

Topical tramadol may be prescribed for people with musculoskeletal pain. Tramadol is not approved for as-needed pain relief. It is not a nonsteroidal anti-inflammatory drug (NSAID). It works differently than NSAIDs and has different side effects.

Why do doctors not prescribe diclofenac? ›

The Feb. 12, 2013 study in PLoS Medicine (2013;10:e1001388) indicates that diclofenac use can increase the risk of heart attack or stroke in patients with pre-existing conditions such as diabetes, high cholesterol or other high risk factors for cardiovascular problems.

What anti-inflammatory is stronger than diclofenac? ›

Oxaprozin was shown to be superior to diclofenac in improving shoulder function and was considered by investigators and patients to have greater overall efficacy than diclofenac. In addition, oxaprozin showed a trend toward superior results in improving patients' quality of life compared with diclofenac.

Is diclofenac the strongest anti-inflammatory? ›

The authors of the study concluded that diclofenac at a dose of 150 mg per day is currently the most effective drug in the treatment of pain and physical disability caused by osteoarthritis (OA), and superior to widely used NSAIDs (including ibuprofen, naproxen and celecoxib) at maximum doses.

Which NSAID is safest for liver? ›

Ibuprofen has the highest liver safety profile among NSAIDs and showed no severe liver injury in larger studies. Along with paracetamol and aspirin, it is considered one of the most common over the counter NSAIDs sold in the world.

Which is safer Tylenol or ibuprofen? ›

In one meta-analysis, ibuprofen was found to be similar to or better than acetaminophen for treating pain and fever in adults and children. Both drugs were also found to be equally safe. One study in the analysis found that acetaminophen is safer with fewer side effects than ibuprofen.

Which NSAID has highest risk of GI side effects? ›

The risk of GI bleeds appears to be highest with ketorolac, and then in decreasing order, piroxicam, indomethacin (Indocin, others), naproxen (Aleve), ketoprofen, meloxicam (Mobic, others), diclofenac (Voltaren, Solaraze, others), and ibuprofen (Advil, Motrin, others).

Is there something better than meloxicam? ›

If you are seeking faster relief from your arthritis pain, Celebrex may be a better option; however, if you are looking for longer-lasting effects, Mobic may be the better choice.

Can you take meloxicam for years? ›

Although 15 mg meloxicam is approved for the management of arthritis-related joint pain, it's not recommended for long-term use.

Can I take meloxicam on an as needed basis? ›

Adults—At first, 5 milligrams (mg) once a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 10 mg per day. Children—Use and dose must be determined by your doctor.

How long can you stay on diclofenac? ›

For arthritis, you may need to use the gel for up to 7 days on the painful joint to feel the full effect. Depending on why you're taking diclofenac, you may only need to take it for a short time. For example, if you have a sore back or toothache, you may only need to take diclofenac for 1 or 2 days.

Can you take diclofenac everyday? ›

When used for severe or continuing arthritis, this medicine must be taken every day as ordered by your doctor in order for it to help you. This medicine usually begins to work within one week, but in severe cases up to two weeks or longer may pass before you begin to feel better.

Which is safer celecoxib or diclofenac? ›

Conclusion: Celecoxib 200 mg daily is as effective as diclofenac 150 mg daily for relieving signs and symptoms of OA of the knee, including pain, and has a rapid onset of action. However, celecoxib appears to have a superior safety and tolerability profile.

Why was naproxen taken off the market? ›

The decision to discontinue production of Naprosyn (naproxen) suspension on a global basis was made because of the discontinuation of one of the flavouring agents. This meant extensive reformulation work, stability testing and then registering the new formulation on a worldwide basis.

Why do doctors tell you not to take Advil? ›

IMPORTANT WARNING:

People who take nonsteroidal anti-inflammatory drugs (NSAIDs) (other than aspirin) such as ibuprofen may have a higher risk of having a heart attack or a stroke than people who do not take these medications. These events may happen without warning and may cause death.

Why you shouldn't take NSAIDs? ›

Nonsteroidal anti-inflammatory drugs (NSAIDs) — medications commonly used to treat pain and inflammation — can increase the risk of a heart attack and stroke. This increase in risk affects people who already have heart disease and those who don't. However, the risk is greater in those who have heart disease.

What is the safest NSAID to take long term? ›

In contrast, naproxen seems to have the safest cardiovascular profile and is the best treatment option in patients with high cardiovascular risk.

Is naproxen stronger than ibuprofen? ›

Both drugs were well-tolerated. Another small study comparing naproxen to ibuprofen found both drugs to be helpful in reducing stiffness, resting pain, movement pain, night pain, interference of the disease with daily activities, and overall disease severity. Naproxen was found to be more effective in this study.

What is the safest anti-inflammatory medication? ›

Experts say that taking NSAIDs for a short time at the lowest effective dose is generally safe.
...
This class of medications includes:
  • Aspirin (full dose)
  • Celecoxib (used in Celebrex)
  • Diclofenac (used in Votaren)
  • Ibuprofen (used in Advil or Motrin)
  • Naproxen (used in Aleve)
Nov 19, 2021

Which is safer Tylenol or ibuprofen? ›

In one meta-analysis, ibuprofen was found to be similar to or better than acetaminophen for treating pain and fever in adults and children. Both drugs were also found to be equally safe. One study in the analysis found that acetaminophen is safer with fewer side effects than ibuprofen.

Which NSAID is safest for kidneys? ›

Ibuprofen was the safest NSAID, conferring a significant 12% increased risk of incident eGFR less than 60, 32% increased risk of an eGFR decline of 30% or greater, and 34% increased risk of the composite outcome. Etoricoxib had the largest negative effect on kidney function.

Which NSAID is safest for liver? ›

Ibuprofen has the highest liver safety profile among NSAIDs and showed no severe liver injury in larger studies. Along with paracetamol and aspirin, it is considered one of the most common over the counter NSAIDs sold in the world.

Which NSAID is easiest on the stomach? ›

Studies have found that ibuprofen and meloxicam may be less likely to bother your stomach, while ketorolac, aspirin, and indomethacin are associated with a higher risk of GI problems.

What can I take instead of ibuprofen for inflammation? ›

Naproxen and aspirin are two other common over-the-counter pain relievers. Reeder describes the uses, benefits and potential problems with these as well: Naproxen. Another anti-inflammatory drug, which works much like ibuprofen.

What is a good substitute for naproxen? ›

The main alternative for pain relief is paracetamol, which is available over the counter and is safe for most people to take.

Is Advil or Aleve better for inflammation? ›

For injuries or inflammatory symptoms, either ibuprofen or naproxen can both reduce inflammation or swelling and manage the pain. However, in the case of prolonged exposure to the sun or tanning, ibuprofen is probably a better alternative to naproxen.

Which NSAID has least effect on blood pressure? ›

Naproxen (Naprosyn) does not increase the risk of hypertension or stroke. Celecoxib (Celebrex) does not increase the risk of hypertension or stroke.

What can I take instead of NSAIDs? ›

Acetaminophen, such as Tylenol, is a widely available alternative to NSAIDs that targets pain rather than inflammation.

Which pain reliever is least harmful to the liver? ›

Certain NSAIDs such as diclofenac and naproxen have been associated with hepatotoxicity. Therefore, low-dose acetaminophen (2 grams or less/day on non-consecutive days) is preferred over NSAIDs in patients with chronic liver disease.

Why do hospitals use Tylenol instead of ibuprofen? ›

Hospitals prefer acetaminophen -- the active ingredient in Tylenol -- because it has fewer side effects than aspirin. And they prefer Tylenol, says Consumer Reports in its June issue, because of the king-size discount the company offers hospitals.

Why do doctors recommend Tylenol over Advil? ›

Advil reduces inflammation, which reduces pain. It works best on pain caused by inflammation, such as pain from RA. Tylenol works to lower your body's pain threshold. It works best for pain that is not specifically from inflammation, such as pain from osteoarthritis.

Who should not take ibuprofen? ›

You shouldn't take ibuprofen if you: have a history of a strong, unpleasant reaction (hypersensitivity) to aspirin or other NSAIDs. have a current or recent stomach ulcer, or you have had one in the past. have severe heart failure.

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