Drug Review

Nonsteroidal Anti-inflammatory Drugs (NSAIDs) Overview

Editors: Eileen I. Yoshida RPh, MBA, FNAP; Alan Ehrlich MD, FAAFP

Next Section >

Background Information

Description

  • NSAIDs are a class of medications with analgesic, anti-inflammatory, and antipyretic effects.,,
  • NSAIDs inhibit prostaglandins, which may lead to both therapeutic and adverse effects.,,

NSAID Classification

NSAID Classification by Chemical Structure and Availability

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      • Lumiracoxib (withdrawn worldwide)
      • Rofecoxib (withdrawn worldwide)
      • Valdecoxib (withdrawn worldwide)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
  • See NSAID differences based on COX selectivity for additional information including adverse effect differences related to COX selectivity.
Next Section >

Published by EBSCO Information Services. Copyright © 2025, EBSCO Information Services. All rights reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission.

EBSCO Information Services accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional.

DynaMed Levels of Evidence

Quickly find and determine the quality of the evidence.

DynaMed provides easy-to-interpret Level of Evidence labels so users can quickly find and determine the quality of the best available evidence. Evidence may be labeled in one of three levels:

1Level 1 (likely reliable) Evidence
Representing research results addressing clinical outcomes and meeting an extensive set of quality criteria which minimizes bias.
There are two types of conclusions which can earn a Level 1 label: levels of evidence for conclusions derived from individual studies and levels of evidence for conclusions regarding a body of evidence.
2Level 2 (mid-level) Evidence
Representing research results addressing clinical outcomes, and using some method of scientific investigation, but not meeting the quality criteria to achieve Level 1 evidence labeling.
3Level 3 (lacking direct) Evidence
Representing reports that are not based on scientific analysis of clinical outcomes. Examples include case series, case reports, expert opinion, and conclusions extrapolated indirectly from scientific studies.

Grades of Recommendation

Guideline producers are now frequently using classification approaches for their evidence and recommendations, and these classifications are recognized and requested by guideline users. When summarizing guideline recommendations for DynaMed users, the DynaMed Editors are using the guideline-specific classifications and providing guideline classification approach when this is done.

Download the full version of Levels of Evidence