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

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Last updated: April 13, 2025 • View editorial policy

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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 blocking cyclooxygenase enzymes to reduce inflammation and pain. Common traditional NSAIDs include ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), aspirin, diclofenac (Voltaren), indomethacin (Indocin), and ketoprofen. These medications are nonselective, meaning they inhibit both COX-1 and COX-2 enzymes. COX-2 selective inhibitors target primarily the COX-2 enzyme, potentially causing fewer gastrointestinal side effects.

Key Points to Consider

  • NSAIDs are available in various formulations including oral tablets, capsules, liquids, topical gels, patches, and injectable forms.
  • When using NSAIDs, it's essential to take the lowest effective dose for the shortest duration possible to minimize side effect risks, which can include stomach irritation, kidney problems, increased blood pressure, and cardiovascular risks with long-term use, as recommended by the 2017 HIVMA of IDSA clinical practice guideline for the management of chronic pain in patients living with HIV 1.
  • People with certain conditions like heart disease, kidney disease, or a history of stomach ulcers should use NSAIDs cautiously and consult their healthcare provider about which type might be safest for their specific situation.

Important Considerations

  • The use of NSAIDs should be carefully evaluated in patients with gastrointestinal, renal, and cardiovascular status, as stated in the 2007 EULAR recommendations for the management of early arthritis 1.
  • The 2011 ACCF/AHA focused update incorporated into the ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction recommends a stepped-care approach to treatment, starting with acetaminophen, small doses of narcotics, or nonacetylated salicylates, and considering nonselective NSAIDs, such as naproxen, if initial therapy is insufficient 1.
  • The 2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis suggests that NSAIDs, including Coxibs, are recommended as first-line drug treatment for AS patients with pain and stiffness, and that cardiovascular, gastrointestinal, and renal risks should be taken into account when prescribing NSAID 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 NSAIDs: inhibit both COX-1 and COX-2 isoenzymes, examples include ibuprofen and naproxen 3
  • Selective NSAIDs: act on COX-1 (e.g. aspirin) or COX-2 (e.g. celecoxib) isoenzymes, respectively 3
  • Preferential COX-2 inhibitors: tolerated by the majority but not all hypersensitive patients, examples include nimesulide and meloxicam 4
  • Selective COX-2 inhibitors: well tolerated by almost all aspirin-sensitive asthmatic patients, examples include celecoxib and rofecoxib (withdrawn from the market) 4

Examples of NSAIDs

  • Ibuprofen: a non-selective NSAID that inhibits both COX-1 and COX-2 isoenzymes 5, 3, 6
  • Naproxen: a non-selective NSAID that inhibits both COX-1 and COX-2 isoenzymes 5, 3, 6
  • Diclofenac: a non-selective NSAID that inhibits both COX-1 and COX-2 isoenzymes, associated with increased risk of serious cardiovascular adverse effects 5
  • Aspirin: a selective NSAID that acts on COX-1 isoenzyme 3, 4, 6
  • Celecoxib: a selective COX-2 inhibitor, well tolerated by almost all aspirin-sensitive asthmatic patients 4
  • Cox-2 inhibitors: associated with increased risk of serious cardiovascular adverse effects, examples include celecoxib and rofecoxib (withdrawn from the market) 5, 3

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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