Anti-inflammatory drugs like aspirin and ibuprofen help relieve pain caused by inflammation. But they can have side effects and interact with other drugs.

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.

The more common OTC NSAIDs include:

  • low dose aspirin (100 mg or below)
  • high dose aspirin (325 mg or above)
  • ibuprofen (Advil, Motrin)
  • naproxen (Aleve, Naprosyn)

NSAIDs can be effective. They 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 and tips on how to use NSAIDs safely and effectively.

NSAIDs work by blocking prostaglandins, which 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 pain and bring down a fever. NSAIDs can be helpful 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. You typically take it twice daily.

Other options for long-term arthritis management include meloxicam (Vivlodex, Mobic), which is taken once a day, and diclofenac (Voltaren), a topical NSAID.

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:

  • low dose aspirin
  • high dose aspirin
  • ibuprofen (Advil, Motrin)
  • 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, including stomach and heart issues.

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

Consider talking with a healthcare professional before using NSAIDs for an extended period, and do not take different types of NSAIDs simultaneously.

Stomach problems

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, 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 talk with a healthcare professional:

  • 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 age 65

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

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

Heart complications

Taking NSAIDs increases your risk for:

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

People with cardiovascular disease have 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:

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 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, a healthcare professional will likely monitor you for high blood pressure and kidney damage while you take them both.

Always check with a healthcare professional 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 6 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 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 can 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 may help relieve arthritis and other inflammatory conditions better.

Read the labels

Some OTC products combine acetaminophen and anti-inflammatory medication. 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 a healthcare professional if you have or have had:

You may also need to consult a healthcare professional before taking NSAIDs if:

  • you’re over age 65
  • you’re pregnant
  • you consume three or more alcoholic beverages daily
  • you take a blood-thinning medication

Research from 2018 found that taking NSAIDs early in your pregnancy may increase your risk for miscarriage. But more studies are necessary.

The FDA recommends not taking NSAIDs in week 20 or later of pregnancy. They can cause a risk of low amniotic fluid and cause kidney problems in infants.

The following includes frequently asked questions about NSAIDs.

What is the most effective anti-inflammatory?

The most effective anti-inflammatory can depend on the condition you are using it to treat. Some people with chronic inflammation may prefer naproxen (Aleve) to ibuprofen (Advil) because the pain relief lasts longer and they don’t have to take it as often. On the other hand, ibuprofen (Advil) can treat pain in children while naproxen (Aleve) is not approved for use in children under age 12.

Depending on the cause of your inflammation, a doctor may recommend a prescription NSAID, such as diclofenac (Zorvolex) or meloxicam (Vivlodex, Mobic).

What is the strongest anti-inflammatory over the counter?

Naproxen (Aleve) is the strongest NSAID available without a prescription. Pain relief lasts longer, so you do not have to take it as often as ibuprofen (Advil).

What reduces inflammation the fastest?

Taking OTC NSAIDs such as ibuprofen (Advil) or naproxen (Aleve) may help relieve inflammation. You may also find relief through cold or heat therapy, gentle stretching and exercise, and rest. How long it takes to relieve inflammation can also depend its cause. For inflammation due to injuries or chronic conditions, a doctor may prescribe stronger NSAIDs.

Is there a stronger anti-inflammatory than ibuprofen?

Naproxen (Aleve) is stronger than ibuprofen (Advil). Doses last longer, so you do not need to take it as often. Stronger NSAIDs may also help reduce inflammation, though they require a prescription.

NSAIDs can help relieve pain caused by inflammation. A healthcare professional can determine the right dosage for your needs. Exceeding that limit may make side effects more likely.

NSAIDs may be also ingredients in certain medications, so be sure to read the label of any OTC drug you take to avoid exceeding the recommended dosage or experiencing a drug interaction.