Drug Review
Nonsteroidal Anti-inflammatory Drugs (NSAIDs) Overview
Editors: Eileen I. Yoshida RPh, MBA, FNAP; Alan Ehrlich MD, FAAFP
Background Information
Description
NSAID Classification
NSAID Classification by Chemical Structure and Availability
- NSAIDs may be classified according to chemical structure.
Table 1: NSAID Classification by Chemical Structure and Availability NSAID Chemical Class Examples of FDA-approved NSAIDs (Routes of Administration) Examples of Additional NSAIDs Available Outside the United States Salicylates - Aspirin (oral, rectal)
- Diflunisal (oral)
- Salsalate (oral)
- None
Acetic acid derivatives - Diclofenac preparations
- Diclofenac (oral)
- Diclofenac potassium (oral)
- Diclofenac sodium (oral, ophthalmic, topical)
- Diclofenac epolamine (topical)
- Etodolac (oral)
- Indomethacin preparations
- Indomethacin (oral)
- Indomethacin sodium (IV)
- Ketorolac (oral, IV, intramuscular, nasal, ophthalmic)
- Nabumetone (oral)
- Sulindac (oral)
- Tolmetin discontinued in the United States; available in other countries such as Mexico and China
Propionic acid derivatives - Fenoprofen (oral)
- Flurbiprofen (oral, ophthalmic)
- Ibuprofen preparations
- Ibuprofen (oral, IV)
- Ibuprofen lysine (IV)
- Ketoprofen (oral)
- Naproxen preparations
- Naproxen (oral)
- Naproxen sodium (oral)
- Oxaprozin (oral)
- Aceclofenac available in countries or regions such as the United Kingdom, European Union, and China
- Tiaprofenic acid available in countries or regions such as the United Kingdom, European Union, Canada, Australia, and New Zealand
Fenamates - Meclofenamate (oral)
- Mefenamic acid (oral)
- None
Enolic acid derivatives - Tenoxicam available in countries or regions such as the United Kingdom, European Union, Canada, and New Zealand
Diaryl heterocyclic COX-2 selective NSAIDs (coxibs) - Celecoxib (oral)
- Etoricoxib available in countries or regions such as the United Kingdom, European Union, Australia, New Zealand, and China
- Parecoxib available in countries or regions such as the United Kingdom, European Union, Australia, New Zealand, and China
Abbreviation: COX-2, cyclooxygenase-2; NSAID, nonsteroidal anti-inflammatory drug.
Reference - Brunton LL, Hilal-Dandan R, Knollmann BC, eds. Goodman & Gilman's: The Pharmacological Basis of Therapeutics. 13th ed. New York, NY: McGraw Hill; 2017, IBM Micromedex, Index Nominum International Drug Directory (accessed 2021 Dec 29).
- Some NSAIDs, such as certain formulations and strengths of ibuprofen, naproxen, and aspirin, are available without a prescription in the United States.
- Some NSAIDs are available in combination with other medications such as other analgesics or gastroprotective agents. Examples of oral combination products include:
NSAID Classification by Cyclooxygenase (COX) Selectivity
- Classification of NSAIDs can also be based on their reported preferential COX selectivity.
- NSAIDs which preferentially inhibit COX-1 include:
- Fenoprofen
- Flurbiprofen
- Ketoprofen
- Oxaprozin
- Tolmetin (discontinued in the United States)
- Nonselective NSAIDs include:
- Ibuprofen
- Indomethacin
- Ketorolac
- Nabumetone
- Naproxen
- Piroxicam
- Sulindac
- NSAIDs with lower COX-2 selectivity include:
- Celecoxib
- Diclofenac
- Etodolac
- Mefenamic acid
- Meloxicam
- Nimesulide (not available in the United States)
- Salsalate
- NSAIDs with higher COX-2 selectivity include:
- Etoricoxib (not available in the United States)
- Lumiracoxib (withdrawn worldwide)
- Rofecoxib (withdrawn worldwide)
- Valdecoxib (withdrawn worldwide)
- PubMed2049644820061101Reference - Can J Cardiol 2021 Nov;37(11):1705
- NSAIDs which preferentially inhibit COX-1 include:
- See NSAID differences based on COX selectivity for additional information including adverse effect differences related to COX selectivity.
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