We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
JAMA Patient Page |

Nonsteroidal Anti-inflammatory Drugs FREE

Jill Jin, MD, MPH
JAMA. 2015;314(10):1084. doi:10.1001/jama.2015.9936.
Text Size: A A A
Published online

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a group of medications commonly used to treat pain and inflammation.

Nonsteroidal anti-inflammatory drugs include ibuprofen, naproxen, diclofenac, meloxicam, and celecoxib, along with many others. They are among the most commonly used medications in the world. Many are available over the counter without a prescription. Aspirin is a type of NSAID that works slightly differently than others.


NSAIDs block a group of proteins called cyclooxygenases (COX), which are involved in the production of prostaglandins and thromboxanes, which are in turn involved in inflammation. There are different types of COX proteins, including COX-1 and COX-2. Some NSAIDs block both COX-1 and COX-2. These are called nonselective NSAIDs and include aspirin, ibuprofen, and naproxen. Selective NSAIDs, such as celecoxib, block only COX-2. There is still much that is not known about how these COX proteins work.


Using a low dose of NSAIDs for a short amount of time is generally safe. However, serious side effects can occur, especially with longer use of higher doses. The most serious side effects are increased risks of heart attack, stroke, stomach ulcers, gastrointestinal bleeding, and kidney disease, especially in people who have a history of these problems.

Compared with nonselective NSAIDs, selective NSAIDs tend to have less gastrointestinal side effects but more cardiovascular side effects. In 2004-2005, some selective (COX 2) inhibitors were withdrawn from the US market because of an increased risk of heart attack and stroke in people who took them. In 2005, the US Food and Drug Administration (FDA) added a warning label to prescription NSAIDs about this increased risk of heart attack and stroke.

On July 9, 2015, the FDA strengthened the warning on all prescription and over-the-counter NSAIDs except aspirin in regard to the increased risk of heart attack and stroke. The new warning states that this increased risk can occur as early as the first weeks of use and occurs in people both with and without other risk factors for heart disease and stroke. Although the data for each NSAID are different and each person’s risk is different, some studies have shown that an extra 2 to 8 per 1000 people per year may have a major vascular event from using an NSAID. The warning also notes that people given NSAIDs after a first heart attack were more likely to die in the first year after the heart attack compared with those who were not given NSAIDs and that there is an increased risk of heart failure with NSAID use.

These warnings do not apply to aspirin, which has been proven effective in preventing heart attacks and strokes in people with increased cardiovascular risk. Taking some NSAIDs within 1 to 3 hours of taking aspirin can interfere with the protective effects of aspirin on the heart.


There is no single best or safest NSAID to use to treat pain. Ask your doctor about which NSAID is best for you, especially if you have a history of heart disease, high blood pressure, gastrointestinal bleeding, or kidney disease. The best way to lower the risk of serious side effects from NSAIDs is to use the lowest amount of NSAIDs for the shortest amount of time needed.

Box Section Ref ID

For More Information

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at www.jama.com. Many are available in English and Spanish.


The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

Source: US Food and Drug Administration

Topic: Drug Therapy




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Spanish Patient Page: Fármacos antiinflamatorios no esteroideos

Supplemental Content

Some tools below are only available to our subscribers or users with an online account.

0 Citations

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles