About 20 types of nonsteroidal anti-inflammatory drugs (NSAIDs) have been approved by the U.S. Food and Drug Administration (FDA). Each type of NSAID affects the body differently, with individuals responding better to some types than others. Physicians often switch between different NSAIDs for a patient to find the drug that is the most effective with the fewest side effects. The choice of one NSAID over another should be made after considering an individual’s risk factors for these potential side effects.

NSAIDs are available both with and without a prescription. Over-the-counter NSAIDs available in the United States include:

Other NSAIDs approved for sale in the United States include:

Most NSAIDs are traditional NSAIDs, which work by suppressing both forms of the enzyme cyclooxygenase (COX). COX-2 inhibitors are a newer type of NSAID that suppress only the COX-2 enzyme, not COX-1 (which is responsible for the prostaglandins in the stomach lining). COX-2 inhibitors are therefore effective in relieving pain with less risk of peptic ulcers. However, they still pose risks. COX-2 inhibitors have been linked to an increased risk of serious cardiovascular problems (e.g., heart attack, stroke) and severe skin reactions (e.g., Stevens Johnson syndrome). Because of this, several COX-2 inhibitors have been withdrawn from the U.S. market. Celecoxib (Celebrex) is the only COX-2 inhibitor currently available in the United States. The FDA is encouraging physicians who prescribe celecoxib to do so at the lowest effective dose and for the shortest possible duration.