Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Ghlichloo I, Gerriets V. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547742/

Wongrakpanich S, Wongrakpanich A, Melhado K, Rangaswami J. A Comprehensive Review of Non-Steroidal Anti-Inflammatory Drug Use in The Elderly. Aging Dis. 2018 Feb 1;9(1):143-150. doi: 10.14336/AD.2017.0306.

Brennan R, Wazaify M, Shawabkeh H, Boardley I, McVeigh J, Van Hout MC. A Scoping Review of Non-Medical and Extra-Medical Use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). Drug Saf. 2021;44(9):917-928. doi:10.1007/s40264-021-01085-9

Negm A.A., & Furst D.E. (2017). Nonsteroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs, nonopioid analgesics, & drugs used in gout. Katzung B.G.(Ed.), Basic & Clinical Pharmacology, 14e. McGraw-Hill Education. https://accessmedicine.mhmedical.com/content.aspx?bookid=2249&sectionid=175221264

Bindu S, Mazumder S, Bandyopadhyay U. Non-steroidal anti-inflammatory drugs (NSAIDs) and organ damage: A current perspective. Biochem Pharmacol. 2020;180:114147. doi:10.1016/j.bcp.2020.114147

Kaduševičius E. Novel Applications of NSAIDs: Insight and Future Perspectives in Cardiovascular, Neurodegenerative, Diabetes and Cancer Disease Therapy. Int J Mol Sci. 2021;22(12):6637. Published 2021 Jun 21. doi:10.3390/ijms22126637

Nugrahani I, Parwati RD. Challenges and Progress in Nonsteroidal Anti-Inflammatory Drugs Co-Crystal Development. Molecules. 2021;26(14):4185. Published 2021 Jul 9. doi:10.3390/molecules26144185

Kowalski ML, Woessner K, Sanak M. Approaches to the diagnosis and management of patients with a history of nonsteroidal anti-inflammatory drug-related urticaria and angioedema. J Allergy Clin Immunol. 2015;136(2):245-251. doi:10.1016/j.jaci.2015.06.021

Chaiamnuay S, Allison JJ, Curtis JR. Risks versus benefits of cyclooxygenase-2-selective nonsteroidal antiinflammatory drugs. Am J Health Syst Pharm. 2006;63(19):1837-1851. doi:10.2146/ajhp050519

NHS. NSAIDs. NHS. Published 2022. https://www.nhs.uk/conditions/nsaids/

Smith HS, Baird W. Meloxicam and selective COX-2 inhibitors in the management of pain in the palliative care population. American Journal of Hospice and Palliative Medicine®. 2003;20(4):297-306. doi:https://doi.org/10.1177/104990910302000413

Diclofenac. Drugs.com. https://www.drugs.com/diclofenac.html

Ibuprofen Uses, Dosage & Side Effects. Drugs.com. https://www.drugs.com/ibuprofen.html#dosage

Ketoprofen Dosage Guide + Max Dose, Adjustments. Drugs.com. https://www.drugs.com/dosage/ketoprofen.html

Naproxen Dosage. Drugs.com. https://www.drugs.com/dosage/naproxen.html

Indomethacin Dosage Guide with Precautions. Drugs.com. https://www.drugs.com/dosage/indomethacin.html

Meloxicam. Drugs.com. https://www.drugs.com/meloxicam.html

Piroxicam Dosage Guide + Max Dose, Adjustments. Drugs.com. https://www.drugs.com/dosage/piroxicam.html

Celecoxib Dosage Guide + Max Dose, Adjustments. Drugs.com. https://www.drugs.com/dosage/celecoxib.html

Arcoxia Uses, Dosage, Side Effects & Warnings. Drugs.com. https://www.drugs.com/arcoxia.html

Aspirin Dosage. Drugs.com. https://www.drugs.com/dosage/aspirin.html

Barkin RL. Topical Nonsteroidal Anti-Inflammatory Drugs: The Importance of Drug, Delivery, and Therapeutic Outcome. Am J Ther. 2015;22(5):388-407. doi:10.1097/MJT.0b013e3182459abd

Singla N, Rock A, Pavliv L. A multi-center, randomized, double-blind placebo-controlled trial of intravenous-ibuprofen (IV-ibuprofen) for treatment of pain in post-operative orthopedic adult patients. Pain Med. 2010;11(8):1284-1293. doi:10.1111/j.1526-4637.2010.00896.x

Imbimbo BP, Solfrizzi V, Panza F. Are NSAIDs useful to treat Alzheimer's disease or mild cognitive impairment?. Front Aging Neurosci. 2010;2:19. Published 2010 May 21. doi:10.3389/fnagi.2010.00019

Jonker C, Comijs HC, Smit JH. Does aspirin or other NSAIDs reduce the risk of cognitive decline in elderly persons? Results from a population-based study. Neurobiol Aging. 2003;24(4):583-588. doi:10.1016/s0197-4580(02)00188-4

Berkes EA. Anaphylactic and anaphylactoid reactions to aspirin and other NSAIDs. Clin Rev Allergy Immunol. 2003;24(2):137-148. doi:10.1385/CRIAI:24:2:137

Faki Y, Er A. Different Chemical Structures and Physiological/Pathological Roles of Cyclooxygenases. Rambam Maimonides Med J. 2021;12(1):e0003. Published 2021 Jan 19. doi:10.5041/RMMJ.10426

Rouzer CA, Marnett LJ. Cyclooxygenases: structural and functional insights. J Lipid Res. 2009;50 Suppl(Suppl):S29-S34. doi:10.1194/jlr.R800042-JLR200

Osani MC, Vaysbrot EE, Zhou M, McAlindon TE, Bannuru RR. Duration of Symptom Relief and Early Trajectory of Adverse Events for Oral Nonsteroidal Antiinflammatory Drugs in Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken). 2020;72(5):641-651. doi:10.1002/acr.23884

Makris UE, Kohler MJ, Fraenkel L. Adverse effects of topical nonsteroidal antiinflammatory drugs in older adults with osteoarthritis: a systematic literature review. J Rheumatol. 2010;37(6):1236-1243. doi:10.3899/jrheum.090935

Griffin MR, Piper JM, Daugherty JR, Snowden M, Ray WA. Nonsteroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons. Ann Intern Med. 1991;114(4):257-263. doi:10.7326/0003-4819-114-4-257

Targownik LE, Thomson PA. Gastroprotective strategies among NSAID users: guidelines for appropriate use in chronic illness. Can Fam Physician. 2006;52(9):1100-1105.

Chan FK, Chung SC, Suen BY, et al. Preventing recurrent upper gastrointestinal bleeding in patients with Helicobacter pylori infection who are taking low-dose aspirin or naproxen. N Engl J Med. 2001;344(13):967-973. doi:10.1056/NEJM200103293441304

Weir MR. Renal effects of nonselective NSAIDs and coxibs. Cleve Clin J Med. 2002;69 Suppl 1:SI53-SI58. doi:10.3949/ccjm.69.suppl_1.si53

Moore N, Pollack C, Butkerait P. Adverse drug reactions and drug-drug interactions with over-the-counter NSAIDs. Ther Clin Risk Manag. 2015;11:1061-1075. Published 2015 Jul 15. doi:10.2147/TCRM.S79135

Curtis SP, Ng J, Yu Q, et al. Renal effects of etoricoxib and comparator nonsteroidal anti-inflammatory drugs in controlled clinical trials. Clin Ther. 2004;26(1):70-83. doi:10.1016/s0149-2918(04)90007-0

Sriuttha P, Sirichanchuen B, Permsuwan U. Hepatotoxicity of Nonsteroidal Anti-Inflammatory Drugs: A Systematic Review of Randomized Controlled Trials. Int J Hepatol. 2018;2018:5253623. Published 2018 Jan 15. doi:10.1155/2018/5253623

Sarges P, Steinberg JM, Lewis JH. Drug-Induced Liver Injury: Highlights from a Review of the 2015 Literature. Drug Saf. 2016;39(9):801-821. doi:10.1007/s40264-016-0427-8

Meunier L, Larrey D. Recent Advances in Hepatotoxicity of Non Steroidal Anti-Inflammatory Drugs. Ann Hepatol. 2018;17(2):187-191. doi:10.5604/01.3001.0010.8633

Schafer AI. Effects of nonsteroidal anti-inflammatory therapy on platelets. Am J Med. 1999;106(5B):25S-36S. doi:10.1016/s0002-9343(99)00114-x

Kenny GN. Potential renal, haematological and allergic adverse effects associated with nonsteroidal anti-inflammatory drugs. Drugs. 1992;44 Suppl 5:31-37. doi:10.2165/00003495-199200445-00005

Onder G, Pellicciotti F, Gambassi G, Bernabei R. NSAID-related psychiatric adverse events: who is at risk?. Drugs. 2004;64(23):2619-2627. doi:10.2165/00003495-200464230-00001

Atukorala I, Hunter DJ. Valdecoxib : the rise and fall of a COX-2 inhibitor. Expert Opin Pharmacother. 2013;14(8):1077-1086. doi:10.1517/14656566.2013.783568

Whelton A, White WB, Bello AE, Puma JA, Fort JG; SUCCESS-VII Investigators. Effects of celecoxib and rofecoxib on blood pressure and edema in patients > or =65 years of age with systemic hypertension and osteoarthritis. Am J Cardiol. 2002;90(9):959-963. doi:10.1016/s0002-9149(02)02661-9

Wise J. NSAIDs are linked to increased risk of venous thromboembolism, study finds. BMJ. 2014;349:g5834. Published 2014 Sep 24. doi:10.1136/bmj.g5834

Cumhur Cure M, Kucuk A, Cure E. NSAIDs may increase the risk of thrombosis and acute renal failure in patients with COVID-19 infection. Therapie. 2020;75(4):387-388. doi:10.1016/j.therap.2020.06.012

Ungprasert P, Srivali N, Wijarnpreecha K, Charoenpong P, Knight EL. Non-steroidal anti-inflammatory drugs and risk of venous thromboembolism: a systematic review and meta-analysis. Rheumatology (Oxford). 2015;54(4):736-742. doi:10.1093/rheumatology/keu408

Schmidt M, Christiansen CF, Horváth-Puhó E, Glynn RJ, Rothman KJ, Sørensen HT. Non-steroidal anti-inflammatory drug use and risk of venous thromboembolism. J Thromb Haemost. 2011;9(7):1326-1333. doi:10.1111/j.1538-7836.2011.04354.x

Barthélémy O, Limbourg T, Collet JP, et al. Impact of non-steroidal anti-inflammatory drugs (NSAIDs) on cardiovascular outcomes in patients with stable atherothrombosis or multiple risk factors. Int J Cardiol. 2013;163(3):266-271. doi:10.1016/j.ijcard.2011.06.015

Park K, Bavry AA. Risk of stroke associated with nonsteroidal anti-inflammatory drugs. Vasc Health Risk Manag. 2014;10:25-32. doi:10.2147/VHRM.S54159

Schwinger RHG. Pathophysiology of Heart Failure. Cardiovascular Diagnosis and Therapy. 2021;11(1):263-276. doi:https://doi.org/10.21037/cdt-20-302

Harrison DG, Coffman TM, Wilcox CS. Pathophysiology of hypertension. Circulation Research. 2021;128(7):847-863. doi:https://doi.org/10.1161/circresaha.121.318082

Ashorobi D, Ameer MA, Fernandez R. Thrombosis. [Updated 2024 Feb 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538430/

Polónia J. Interaction of antihypertensive drugs with anti-inflammatory drugs. Cardiology. 1997;88 Suppl 3:47-51. doi:10.1159/000177507

Spence JD, Grosser T, FitzGerald GA. Acetaminophen, Nonsteroidal Anti-Inflammatory Drugs, and Hypertension. Hypertension. 2022;79(9):1922-1926. doi:https://doi.org/10.1161/hypertensionaha.122.19315

Fournier JP, Sommet A, Bourrel R, et al. Non-steroidal anti-inflammatory drugs (NSAIDs) and hypertension treatment intensification: a population-based cohort study. Eur J Clin Pharmacol. 2012;68(11):1533-1540. doi:10.1007/s00228-012-1283-9

White WB. Cardiovascular effects of the cyclooxygenase inhibitors. Hypertension. 2007;49(3):408-418. doi:10.1161/01.HYP.0000258106.74139.25

Ishiguro C, Fujita T, Omori T, Fujii Y, Mayama T, Sato T. Assessing the effects of non-steroidal anti-inflammatory drugs on antihypertensive drug therapy using post-marketing surveillance database. J Epidemiol. 2008;18(3):119-124. doi:10.2188/jea.je2007413

Zanchetti A, Hansson L, Leonetti G, et al. Low-dose aspirin does not interfere with the blood pressure-lowering effects of antihypertensive therapy. J Hypertens. 2002;20(5):1015-1022. doi:10.1097/00004872-200205000-00038

Aljadhey H, Tu W, Hansen RA, Blalock SJ, Brater DC, Murray MD. Comparative effects of non-steroidal anti-inflammatory drugs (NSAIDs) on blood pressure in patients with hypertension. BMC Cardiovasc Disord. 2012;12:93. Published 2012 Oct 24. doi:10.1186/1471-2261-12-93

Ruschitzka F, Borer JS, Krum H, et al. Differential blood pressure effects of ibuprofen, naproxen, and celecoxib in patients with arthritis: the PRECISION-ABPM (Prospective Randomized Evaluation of Celecoxib Integrated Safety Versus Ibuprofen or Naproxen Ambulatory Blood Pressure Measurement) Trial. Eur Heart J. 2017;38(44):3282-3292. doi:10.1093/eurheartj/ehx508

Bleumink GS, Feenstra J, Sturkenboom MC, Stricker BH. Nonsteroidal anti-inflammatory drugs and heart failure. Drugs. 2003;63(6):525-534. doi:10.2165/00003495-200363060-00001

Malki A, Langner S, Lyon C. Do NSAIDs increase the risk of congestive heart failure? Evidence-Based Practice. 2019;22(10):1-2. doi:https://doi.org/10.1097/ebp.0000000000000631

Holt A, Strange JE, Nouhravesh N, et al. Heart Failure Following Anti-Inflammatory Medications in Patients With Type 2 Diabetes Mellitus. Journal of the American College of Cardiology. 2023;81(15):1459-1470. doi:https://doi.org/10.1016/j.jacc.2023.02.027

Arfè A, Scotti L, Varas-Lorenzo C, et al. Non-steroidal anti-inflammatory drugs and risk of heart failure in four European countries: nested case-control study. BMJ. 2016;354:i4857. doi:https://doi.org/10.1136/bmj.i4857

Krijthe BP, Heeringa J, Hofman A, Franco OH, Stricker BH. Non-steroidal anti-inflammatory drugs and the risk of atrial fibrillation: a population-based follow-up study. BMJ Open. 2014;4(4):e004059. Published 2014 Apr 8. doi:10.1136/bmjopen-2013-004059

Chokesuwattanaskul R, Chiengthong K, Thongprayoon C, et al. Nonsteroidal anti-inflammatory drugs and incidence of atrial fibrillation: a meta-analysis. QJM. 2020;113(2):79-85. doi:10.1093/qjmed/hcz307

Schjerning Olsen AM, Fosbøl EL, Pallisgaard J, et al. NSAIDs are associated with increased risk of atrial fibrillation in patients with prior myocardial infarction: a nationwide study. Eur Heart J Cardiovasc Pharmacother. 2015;1(2):107-114. doi:10.1093/ehjcvp/pvv004

Bally M, Dendukuri N, Rich B, et al. Risk of acute myocardial infarction with NSAIDs in real world use: bayesian meta-analysis of individual patient data. BMJ. 2017;357:j1909. Published 2017 May 9. doi:10.1136/bmj.j1909

Kang DO, An H, Park GU, et al. Cardiovascular and Bleeding Risks Associated With Nonsteroidal Anti-Inflammatory Drugs After Myocardial Infarction. Journal of the American College of Cardiology. 2020;76(5):518-529. doi:https://doi.org/10.1016/j.jacc.2020.06.017

Ribeiro H, Rodrigues I, Napoleão L, et al. Non-steroidal anti-inflammatory drugs (NSAIDs), pain and aging: Adjusting prescription to patient features. Biomed Pharmacother. 2022;150:112958. doi:10.1016/j.biopha.2022.112958

Patrício JPH, Barbosa JPP, Ramos RMM, Antunes NFP, de Melo PCS. Relative Cardiovascular and Gastrointestinal Safety of Non-selective Non-steroidal Anti-inflammatory Drugs Versus Cyclo-oxygenase-2 Inhibitors. Clinical Drug Investigation. 2013;33(3):167-183. doi:https://doi.org/10.1007/s40261-013-0052-6

Bombardier C, Laine L, Reicin A, et al. Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. VIGOR Study Group. N Engl J Med. 2000;343(21):1520-1528. doi:10.1056/NEJM200011233432103

Kearney PM, Baigent C, Godwin J, Halls H, Emberson JR, Patrono C. Do selective cyclo-oxygenase-2 inhibitors and traditional non-steroidal anti-inflammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trials. BMJ (Clinical research ed). 2006;332(7553):1302-1308. doi:https://doi.org/10.1136/bmj.332.7553.1302

McGettigan P, Henry D. Cardiovascular Risk with Non-Steroidal Anti-Inflammatory Drugs: Systematic Review of Population-Based Controlled Observational Studies. Strom BL, ed. PLoS Medicine. 2011;8(9):e1001098. doi:https://doi.org/10.1371/journal.pmed.1001098

Trelle S, Reichenbach S, Wandel S, et al. Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. BMJ. 2011;342(jan11 1):c7086-c7086. doi:https://doi.org/10.1136/bmj.c7086

Varas-Lorenzo C, Riera-Guardia N, Calingaert B, et al. Myocardial infarction and individual nonsteroidal anti-inflammatory drugs meta-analysis of observational studies. Pharmacoepidemiology and Drug Safety. 2013;22(6):559-570. doi:https://doi.org/10.1002/pds.3437

Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. The Lancet. 2013;382(9894):769-779. doi:https://doi.org/10.1016/s0140-6736(13)60900-9

Fosbøl EL, Folke F, Jacobsen S, et al. Cause-Specific Cardiovascular Risk Associated With Nonsteroidal Antiinflammatory Drugs Among Healthy Individuals. Circulation: Cardiovascular Quality and Outcomes. 2010;3(4):395-405. doi:https://doi.org/10.1161/circoutcomes.109.861104

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Cannon CP, Curtis SP, FitzGerald GA, et al. Cardiovascular outcomes with etoricoxib and diclofenac in patients with osteoarthritis and rheumatoid arthritis in the Multinational Etoricoxib and Diclofenac Arthritis Long-term (MEDAL) programme: a randomised comparison. The Lancet. 2006;368(9549):1771-1781. doi:https://doi.org/10.1016/s0140-6736(06)69666-9

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Dong YH, Chang CH, Wu LC, Hwang JS, Toh S. Comparative cardiovascular safety of nonsteroidal anti-inflammatory drugs in patients with hypertension: a population-based cohort study. British Journal of Clinical Pharmacology. 2018;84(5):1045-1056. doi:https://doi.org/10.1111/bcp.13537