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Overview

Over-the-counter (OTC) medications are drugs that you can buy without a doctor’s prescription. Nonsteroidal anti-inflammatory drugs (NSAIDs) are drugs that help reduce inflammation, which often helps to relieve pain. In other words, they’re anti-inflammatory drugs.

Here are the more common OTC NSAIDs:

  • high-dose aspirin
  • ibuprofen (Advil, Motrin, Midol)
  • naproxen (Aleve, Naprosyn)

NSAIDs can be very effective. They tend to work quickly and generally have fewer side effects than corticosteroids, which also lower inflammation.

Nevertheless, before you use an NSAID, you should know about the possible side effects and drug interactions. Read on for this information as well as tips on how to use NSAIDs safely and effectively.

NSAIDs work by blocking prostaglandins, which are substances that sensitize your nerve endings and enhance pain during inflammation. Prostaglandins also play a role in controlling your body temperature.

By inhibiting the effects of prostaglandins, NSAIDs help relieve your pain and bring down your fever. In fact, NSAIDs can be useful in reducing many types of discomfort, including:

NSAIDs are especially important for managing the symptoms of arthritis, such as joint pain, inflammation, and stiffness. NSAIDs tend to be inexpensive and easily accessible, so they’re often the first medications prescribed to people with arthritis.

The prescription drug celecoxib (Celebrex) is often prescribed for long-term management of arthritis symptoms. This is because it’s easier on your stomach than other NSAIDs.

NSAIDs block the enzyme cyclooxygenase (COX) from creating prostaglandins. Your body produces two types of COX: COX-1 and COX-2.

COX-1 protects your stomach lining, while COX-2 causes inflammation. Most NSAIDs are nonspecific, which means that they block both COX-1 and COX-2.

Nonspecific NSAIDs that are available over the counter in the United States include:

  • high-dose aspirin
  • ibuprofen (Advil, Motrin, Midol)
  • naproxen (Aleve, Naprosyn)

Low-dose aspirin isn’t typically categorized as an NSAID.

Nonspecific NSAIDs that are available with a prescription in the United States include:

Selective COX-2 inhibitors are NSAIDs that block more COX-2 than COX-1. Celecoxib (Celebrex) is currently the only selective COX-2 inhibitor available by prescription in the United States.

Just because you can buy some NSAIDs without a prescription doesn’t mean they’re completely harmless. There are possible side effects and risks, with the most common being upset stomach, gas, and diarrhea.

NSAIDs are intended for occasional and short-term use. Your risk for side effects increases the longer you use them.

Always talk to your healthcare provider before using NSAIDs, and don’t take different types of NSAIDs at the same time.

NSAIDs block COX-1, which helps protect your stomach lining. As a result, taking NSAIDs can contribute to minor gastrointestinal problems, including:

In more serious cases, taking NSAIDs can irritate your stomach lining enough to cause an ulcer. Some ulcers can even lead to internal bleeding.

If you experience any of the following symptoms, stop using the NSAID immediately and call your healthcare provider:

  • severe abdominal pain
  • black or tarry stool
  • blood in your stool

The risk of developing stomach issues is higher for people who:

  • take NSAIDs frequently
  • have a history of stomach ulcers
  • take blood thinners or corticosteroids
  • are over the age of 65

You can decrease your likelihood of developing stomach issues by taking NSAIDs with food, milk, or an antacid.

If you develop gastrointestinal issues, your healthcare provider may encourage you to switch to a selective COX-2 inhibitor such as celecoxib (Celebrex). They’re less likely to cause stomach irritation than nonspecific NSAIDs.

Taking NSAIDs increases your risk for:

The risk of developing these conditions increases with frequent use and higher dosages.

People with cardiovascular disease are at an increased risk of developing heart-related issues from taking NSAIDs.

Stop taking the NSAID immediately and seek medical attention if you experience any of the following symptoms:

  • ringing in your ears
  • blurry vision
  • rash, hives, and itching
  • fluid retention
  • blood in your urine or stools
  • vomiting and blood in your vomit
  • severe stomach pain
  • chest pain
  • rapid heart rate
  • jaundice

NSAIDs can interact with other medications. Some drugs become less effective when they interact with NSAIDs. Two examples are blood pressure medications and low-dose aspirin (when used as a blood thinner).

Other drug combinations can cause serious side effects, too. Exercise caution if you take the following drugs:

  • Warfarin. NSAIDs can actually enhance the effect of warfarin (Coumadin), a medication used to prevent or treat blood clots. The combination can lead to excessive bleeding.
  • Cyclosporine. Cyclosporine (Neoral, Sandimmune) is used to treat arthritis or ulcerative colitis (UC). It’s also prescribed to people who’ve had an organ transplant. Taking it with an NSAID can lead to kidney damage.
  • Lithium. Combining NSAIDs with the mood-stabilizing drug lithium can lead to a dangerous buildup of lithium in your body.
  • Low-dose aspirin. Taking NSAIDs with low-dose aspirin can increase the risk of developing stomach ulcers.
  • Selective serotonin reuptake inhibitors (SSRIs). Bleeding within the digestive system may also be a problem if you take NSAIDs with selective serotonin reuptake inhibitors (SSRIs).
  • Diuretics. It’s usually not a problem to take NSAIDs if you also take diuretics. However, your healthcare provider should monitor you for high blood pressure and kidney damage while you take them both.

Always check with your healthcare provider before giving any NSAIDs to a child younger than 2 years old. Dosage for children is based on weight, so read the dosage chart included with the drug to determine how much to give to a child.

Ibuprofen (Advil, Motrin, Midol) is the most commonly used NSAID in children. It’s also the only one approved for use in children as young as 3 months old. Naproxen (Aleve, Naprosyn) can be given to children over the age of 12 years old.

Although aspirin is approved for use in children over the age of 3 years old, children ages 17 and under who may have chickenpox or flu should avoid aspirin and products containing it.

Giving aspirin to children can increase their risk for Reye’s syndrome, a serious condition that causes swelling in the liver and brain.

Reye’s syndrome

Early symptoms of Reye’s syndrome often occur during recovery from a viral infection, such as the chickenpox or flu. However, a person can also develop Reye’s syndrome 3 to 5 days after the onset of the infection.

Initial symptoms in children under 2 years oldincludediarrhea and rapid breathing. Initial symptoms in older children and teenagers include vomiting and unusual sleepiness.

More severe symptoms include:

Early diagnosis and treatment can be lifesaving. If you suspect that your child has Reye’s syndrome, seek medical attention immediately.

To get the best results from your OTC treatment, follow these tips.

Assess your needs

Some OTC medications, such as acetaminophen (Tylenol), are good for relieving pain but don’t help with inflammation. If you can tolerate them, NSAIDs are probably the better choice for arthritis and other inflammatory conditions.

Read the labels

Some OTC products combine acetaminophen and anti-inflammatory medicine. NSAIDs can be found in some cold and flu medications. Be sure to read the ingredients list on all OTC medications so you know how much of each drug you’re taking.

Taking too much of an active ingredient in combination products increases your risk of side effects.

Store them properly

OTC medications can lose their effectiveness before the expiration date if stored in a hot, humid place, such as the bathroom medicine cabinet. To make them last, keep them in a cool, dry place.

Take the correct dose

When taking an OTC NSAID, be sure to read and follow the directions. Products vary in strength, so make sure you’re taking the right amount each time.

NSAIDs aren’t a good idea for everybody. Before taking these medications, check with your healthcare provider if you have or have had:

Consult your healthcare provider if you’re over 65 years old and plan to take NSAIDs.

If you’re pregnant, consult your healthcare provider before taking NSAIDs. Some research has found that taking NSAIDs early in your pregnancy may increase your risk for miscarriage, but more studies are necessary.

Taking NSAIDs during the third trimester of pregnancy isn’t recommended. They can cause a blood vessel in the baby’s heart to close prematurely.

You should also talk to your healthcare provider about the safety of using an NSAID if you consume three or more alcoholic beverages a day or if you take blood-thinning medication.

NSAIDs can be great for relieving pain caused by inflammation, and many are available over the counter. Ask your healthcare provider about the right dosage, and don’t exceed that limit.

NSAIDs may be ingredients in certain medications, so be sure to read the label of any OTC drug you take.