NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) are among the most commonly used medicines worldwide for pain, inflammation, and fever. Drugs like indomethacin, ibuprofen, naproxen, and ketorolac work by blocking prostaglandin synthesis, offering fast symptom relief without using steroids. However, they differ significantly in strength, duration, safety profile, and ideal use cases.
This comprehensive guide explains how NSAIDs work, when to use each drug, dosing principles, comparisons, side effects, precautions, and common mistakes, helping students, clinicians, and general readers choose the right NSAID safely.
What Are NSAIDs?
NSAIDs are a class of drugs that provide:
- Analgesic (pain relief)
- Anti-inflammatory
- Antipyretic (fever-reducing) effects
They are widely used in:
- Musculoskeletal pain
- Arthritis
- Post-operative pain
- Dysmenorrhea
- Headache and migraine
Core Mechanism of Action
NSAIDs inhibit Cyclooxygenase enzymes (COX-1 and COX-2), which are responsible for producing Prostaglandins.
What This Means Clinically
- ↓ Prostaglandins → ↓ Pain & inflammation
- ↓ Gastric protection → GI side effects
- ↓ Renal prostaglandins → Kidney risk
.jpg "NSAIDs - Indomethacin vs Ibuprofen vs Naproxen vs Ketorolac")
Major NSAIDs Covered in This Guide
Indomethacin
Overview
Indomethacin is a potent NSAID with strong anti-inflammatory action but higher side-effect risk.
Key Uses
- Acute gout attack
- Ankylosing spondylitis
- Rheumatoid arthritis
- Closure of Patent Ductus Arteriosus (neonatal use)
Pros
- Very powerful anti-inflammatory
- Effective in gout & PDA
Cons
- CNS side effects (headache, dizziness)
- High GI toxicity
Ibuprofen
Overview
Ibuprofen is the most commonly used NSAID globally, balancing efficacy and safety.
Key Uses
- Mild to moderate pain
- Fever
- Dysmenorrhea
- Pediatric pain & fever
Pros
- Safer GI profile (low doses)
- OTC availability
- Suitable for children
Cons
- Short duration
- Less potent anti-inflammatory
Naproxen
Overview
Naproxen offers long-lasting pain relief with relatively lower cardiovascular risk.
Key Uses
- Osteoarthritis
- Rheumatoid arthritis
- Chronic musculoskeletal pain
Pros
- Long half-life (12–15 hrs)
- Better CV safety than many NSAIDs
Cons
- Higher GI risk than ibuprofen
- Slower onset
Ketorolac
Overview
Ketorolac is a very strong analgesic NSAID, often compared to opioids for pain relief.
Key Uses
- Post-operative pain
- Renal colic
- Acute severe pain (short-term)
Pros
- Opioid-level analgesia
- Injectable & oral forms
Cons
- Maximum use: 5 days
- High GI bleeding risk
- Renal toxicity
NSAIDs Comparison Table
| Feature | Ibuprofen | Naproxen | Indomethacin | Ketorolac |
|---|---|---|---|---|
| Analgesic strength | Mild-mod | Moderate | Strong | Very strong |
| Anti-inflammatory | Moderate | High | Very high | Moderate |
| Duration | Short | Long | Medium | Short |
| GI risk | Low | Moderate | High | Very high |
| Renal risk | Low | Moderate | High | High |
| Max duration | Long-term | Long-term | Limited | ≤5 days |
Common Clinical Uses of NSAIDs
- Osteoarthritis & Rheumatoid arthritis
- Acute gout
- Post-operative pain
- Dysmenorrhea
- Headache & migraine
- Fever (antipyretic)
Side Effects of NSAIDs
Gastrointestinal
- Gastritis
- Peptic ulcer
- GI bleeding
Renal
- Acute kidney injury
- Sodium & water retention
Cardiovascular
- Hypertension
- ↑ Thrombotic risk (varies by drug)
CNS (esp. Indomethacin)
- Headache
- Dizziness
- Confusion
Contraindications
- Active peptic ulcer disease
- Chronic kidney disease
- Severe heart failure
- Third trimester of pregnancy
- NSAID-induced asthma
Actionable Dosing Principles
1. Lowest effective doseCommon Mistakes & Fixes
❌ Using ketorolac >5 days → Strictly limit duration
❌ NSAIDs in CKD → Use paracetamol instead
❌ Combining NSAIDs → No added benefit, more harm
❌ Ignoring GI protection → Add PPI when needed
FAQs
Which NSAID is safest?
Ibuprofen (low dose) has the best overall safety profile.
Which NSAID is strongest?
Ketorolac (analgesic) and indomethacin (anti-inflammatory).
Can NSAIDs be used long-term?
Yes, but with monitoring & GI protection.
Are NSAIDs steroids?
No—NSAIDs are non-steroidal anti-inflammatory drugs.
Which NSAID is best for arthritis?
Naproxen or ibuprofen for long-term use.
