How Do NSAIDs Work?

NSAIDs work by blocking a group of enzymes called cyclo-oxygenase — COX-1 and COX-2 — from producing prostaglandins. Prostaglandins are hormone-like chemicals that are one of the biggest contributors to inflammation. They also affect blood flow and clotting. By inhibiting the synthesis of prostaglandins, NSAIDs reduce pain and inflammation, lower fever, and extend clotting times.

COX-1 and COX-2 perform different actions. COX-1 protects the lining of the stomach, activates platelets that cause blood clotting, and helps with kidney function. COX-2 is produced as a result of a joint injury or inflammation. Medical understanding of COX-1 and COX-2 has advanced over the years, allowing for the development of various forms of NSAIDs.

COX-2 inhibitors target COX-2 without affecting the COX-1 enzyme. Because of this, they generally do not have the same risks as other NSAIDs, as they do not cause as much stomach upset or bleeding. COX-2 inhibitors should not be taken at the same time as a traditional NSAID.

NSAIDs come with some serious risks. They may raise the risk of heart disease, heart attack, and stoke. People who already have heart problems are most susceptible, but anyone taking NSAIDs is at risk. The medications can also cause kidney damage, especially in individuals who don't drink enough fluid while taking them. Anyone with chronic kidney disease, heart disease, or hypertension should talk to their doctor before taking NSAIDs.

NSAIDs treat a variety of conditions, including backaches, muscle aches, dental pain, menstrual cramps, and pain from rheumatoid arthritis, tendonitis, and osteoarthritis. Generally, they are effective for mild to moderate pain. NSAIDs can also lower fevers and treat aches and pains caused by some infections, like the common cold.

Because NSAIDs have serious risks and side effects, some people should talk to a doctor before taking them. NSAIDs and blood thinners should never be taken together. People with certain conditions, including GERD, Crohn's disease, heart disease, liver damage, stomach ulcers, and heart disease, should talk to their doctor before taking NSAIDs.

Do not take NSAIDs for long periods. When taking over-the-counter NSAIDs, you should not use them for longer than three days for fever or 10 days for pain without the permission of a doctor. When using NSAIDs for longer, it is very important to watch for side effects.

Some NSAIDs work in as little as a few hours while others may take one to two weeks, depending on the type. Generally, those that work quickly are taken more frequently, sometimes every four to six hours. For conditions that require long-term treatment, like rheumatoid arthritis or osteoarthritis, doctors prefer longer-acting NSAIDs taken once or twice a day.

NSAIDs come in many doses and strengths. Lower doses are available over-the-counter, but doctors sometimes prescribe higher doses to treat certain conditions. NSAIDs work differently for everyone, and some people need to try several types before they find one that works. Never increase the dose without talking to the doctor first.

In addition to the serious risks associated with taking NSAIDs, some milder side effects can also occur. The most frequent are heartburn, bloating, gas, constipation, and diarrhea. Others include dizziness, lightheadedness, difficulty concentrating, and problems with balance. Some side effects — including bleeding, severe stomach pain, jaundice, ringing in the ears, chest pain, blurred vision, and difficulty breathing — require urgent medical care.