There are about 20 non-steroidal anti-inflammatory drugs sold in the United States, but a handful dominate the market: aspirin, ibuprofen, naproxen, and celecoxib.
The strength of the medications varies. Typically, the prescription version is two or four times as strong as those sold over the counter. Doctors often have specific instructions on the dosage and timing based on an individual’s situation, making it important to follow the directions carefully and not exceed the listed dose.
See Types of NSAIDs
Aspirin (Bayer, Bufferin, Ecotrin, St. Joseph)
In addition to easing pain, aspirin has another use: preventing heart attacks and stroke. While NSAIDs in general carry a higher risk for heart problems, aspirin is an exception. Doctors often recommend that patients at risk for cardiovascular problems take a single low-dose aspirin each day as a preventive measure.
Individuals taking daily aspirin should be aware that using other NSAIDs at the same time can thwart aspirin’s crucial anti-clotting ability and increase the risk of stomach bleeding. When aspirin is taken daily for the heart, it must be taken first thing in the morning, and no other NSAIDs can be taken for at least one or two hours afterward. Discussing NSAID use with the doctor is advised in this situation.
There are several different strengths of aspirin available. Aspirin is usually taken every 4 to 6 hours. Low-dose aspirin is typically 81 mg per tablets. Regular strength aspirin typically has 325 mg per tablet, and up to two tablets may be taken every four hours. Individuals taking the regular dose should not take more than 12 tablets (3,900 mg) in 24 hours. The maximum daily dose is 4,000 mg in 24 hours. Aspirin should not be given to children under age 12 or to adolescents with chicken pox or flu symptoms because of the possibility of Reye syndrome. Ringing in the ears can occur in patients taking high doses.
Ibuprofen (Advil, Motrin)
Ibuprofen, one of the older NSAIDs, is most commonly recommended to relieve mild or moderate back pain and inflammation.
The typical recommended dose for ibuprofen is 200 to 400 mg taken every 4 to 6 hours, but prescription doses can be as high as 800 mg. The maximum dose for a 24-hour period is 3,200 mg—equal to 4 maximum doses. Ibuprofen can be dosed for children as young as 6 months old.
Naproxen (Aleve, Anaprox DS, Naprosyn)
An analysis of multiple studies indicated that naproxen was associated with a lower risk of cardiovascular problems than other NSAIDs, but the FDA has not found the evidence to be strong enough to make a change on NSAID labels.2
Naproxen sodium 220 mg is equivalent to 200 mg of naproxen. The regular adult dose is one or two 220 mg pills taken within an hour. If pain relief is still needed after 8 to 12 hours, another pill may be taken. A maximum of three pills may be taken in 24 hours. Higher prescription dosages are available and may be prescribed by a doctor, depending on the patient’s situation. Naproxen can be used in children 2 years and older. Older adults may require lower doses.
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Unlike other NSAIDs, COX-2 inhibitors do not impair blood clotting, so they are considered safer for patients taking blood-thinning medications, such as warfarin (brand name Coumadin). Available in 100mg and 200mg tablets, celecoxib is dosed once or twice daily with a maximum daily dose of 800 mg. Celecoxib is used for juvenile rheumatoid arthritis in children as young as 2 years old. Celecoxib is contraindicated in those with sulfonamide, aspirin, or NSAID allergies or in those with certain cardiovascular or gastrointestinal risk factors.
Individuals differ widely in how their bodies respond to medication. If the first medication tried doesn’t seem to have the desired effect, it may be necessary to try other kinds to get relief.
- Bhala N, et al. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomized trials. The Lancet, Vol. 382, No. 9894, p769-779, 31 August 2013.