What are the types of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)?

From the Guidelines

Nonsteroidal anti-inflammatory drugs (NSAIDs) include several types, such as traditional NSAIDs (e.g., ibuprofen, naproxen, aspirin) and COX-2 selective inhibitors (e.g., celecoxib), which work by inhibiting cyclooxygenase enzymes to reduce inflammation and pain. These medications can be categorized into:

• Traditional NSAIDs: ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), aspirin, diclofenac (Voltaren), indomethacin (Indocin), and ketoprofen, which are nonselective, meaning they inhibit both COX-1 and COX-2 enzymes 1.
• COX-2 selective inhibitors: celecoxib (Celebrex), which were developed to reduce gastrointestinal side effects 1.
• Topical NSAIDs: diclofenac gel, which provide localized relief with fewer systemic effects. NSAIDs are available in various formulations, including oral tablets, capsules, liquids, suppositories, and topical preparations. Dosing varies by medication and condition being treated. When using NSAIDs, it's essential to take the lowest effective dose for the shortest duration possible to minimize risks of gastrointestinal bleeding, cardiovascular events, and kidney problems, especially in older adults or those with underlying health conditions 1.

From the FDA Drug Label

NSAID medicines that need a prescription Generic Name Trade Name Celecoxib Celebrex® Diclofenac Cataflam®, Voltaren®, ArthrotecTM (combined with misoprostol) Diflunisal Dolobid® Etodolac Lodine®, Lodine® XL Fenoprofen Nalfon®, Nalfon® 200 Flurbiprofen Ansaid® Ibuprofen Motrin®, Tab-Profen®, Vicoprofen®* (combined with hydrocodone), CombunoxTM (combined with oxycodone) Indomethacin Indocin®, Indocin® SR, Indo-LemmonTM, IndomethaganTM Ketoprofen Oruvail® Ketorolac Toradol® Mefenamic Acid Ponstel® Meloxicam Mobic® Nabumetone Relafen® Naproxen Naprosyn®, Anaprox®, Anaprox® DS, EC-Naproxyn®, Naprelan®, Naprapac® (copackaged with lansoprazole) Oxaprozin Daypro® Piroxicam Feldene® Sulindac Clinoril® Tolmetin Tolectin®, Tolectin® DS, Tolectin® 600

The types of NSAIDs include:

• Celecoxib (Celebrex®)
• Diclofenac (Cataflam®, Voltaren®, ArthrotecTM)
• Diflunisal (Dolobid®)
• Etodolac (Lodine®, Lodine® XL)
• Fenoprofen (Nalfon®, Nalfon® 200)
• Flurbiprofen (Ansaid®)
• Ibuprofen (Motrin®, Tab-Profen®, Vicoprofen®, CombunoxTM)
• Indomethacin (Indocin®, Indocin® SR, Indo-LemmonTM, IndomethaganTM)
• Ketoprofen (Oruvail®)
• Ketorolac (Toradol®)
• Mefenamic Acid (Ponstel®)
• Meloxicam (Mobic®)
• Nabumetone (Relafen®)
• Naproxen (Naprosyn®, Anaprox®, Anaprox® DS, EC-Naproxyn®, Naprelan®, Naprapac®)
• Oxaprozin (Daypro®)
• Piroxicam (Feldene®)
• Sulindac (Clinoril®)
• Tolmetin (Tolectin®, Tolectin® DS, Tolectin® 600) 2

From the Research

Types of NSAIDs

• Non-selective COX inhibitors, such as ibuprofen and naproxen, which are associated with higher gastrointestinal risk 3, 4, 5
• Selective COX-2 inhibitors, such as celecoxib and etoricoxib, which are associated with higher cardiovascular risk 3, 4, 5, 6
• NSAIDs with lower renal excretion and phase 2 metabolism, such as acemetacin and diclofenac, which may be less likely to induce adverse effects and drug-drug interactions 4

Examples of NSAIDs

• Ibuprofen: a non-selective COX inhibitor with a higher gastrointestinal risk, but may be safer for the cardiovascular system at lower doses (less than 1200 mg per day) 5
• Naproxen: a non-selective COX inhibitor with a higher gastrointestinal risk, but may be safer for the cardiovascular system 3, 5
• Celecoxib: a selective COX-2 inhibitor with a lower gastrointestinal risk, but may have a higher cardiovascular risk 3, 6
• Etoricoxib: a selective COX-2 inhibitor with a lower gastrointestinal risk, but may have a higher cardiovascular risk and destabilize blood pressure control 6
• Diclofenac: a non-selective COX inhibitor with a higher gastrointestinal risk and cardiovascular risk 5, 6
• Acemetacin: an NSAID with lower renal excretion and phase 2 metabolism, which may be less likely to induce adverse effects and drug-drug interactions 4
• Etodolac: an NSAID with lower renal excretion and phase 2 metabolism, which may be less likely to induce adverse effects and drug-drug interactions 4

Mechanism of Action

• NSAIDs inhibit cyclooxygenase 1 and 2 (COX1, 2) enzymes, which catalyze the conversion of arachidonic acid into prostaglandins 7
• NSAIDs can also inhibit TRPM7 channels by cytosolic acidification, which may be a novel mechanism of action 7