The Best Over-the-Counter Anti-Inflammatory Medications

Anti-inflammatory medications are commonly used for disorders caused by inflammation, such as arthritis, tendonitis and bursitis. They are also effective for reducing a fever and for treating mild to moderate pain from a wide variety of causes, including menstrual cramps, injuries and minor surgery. Anti-inflammatory medications include corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) 5. Most anti-inflammatories require a prescription.

Only a few NSAIDs are sold as over-the-counter medications -- naproxen, ibuprofen and acetylsalicylic acid (ASA). The effectiveness of these drugs is generally similar, but some people find that 1 drug is more effective for them than the others. The side effects of ASA differ slightly from the side effects of naproxen and ibuprofen.

Naproxen

Naproxen (Aleve, Naprosyn) effectively reduces inflammation, fever and pain in many conditions, but it may produce serious side effects. Naproxen can irritate the stomach, leading to gastritis and ulcers. Bleeding may occur with these conditions and can be worsened by naproxen’s ability to interfere with the function of platelets -- the cell-like structures in blood responsible for forming blood clots.

Rarely, naproxen may lead to a heart attack or stroke. This is more likely in people with pre-existing heart or circulation problems and in individuals who take naproxen for a prolonged period of time.

Ibuprofen

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Ibuprofen (Advil, Motrin, Midol) is also effective for a large number of inflammatory conditions, as well as fever and pain. A study examining pain after dental surgery published in the July 2008 issue of “European Journal of Clinical Pharmacology” reported that 96 percent of people taking ibuprofen had pain relief, but only 67 percent of those taking acetaminophen (Tylenol) had relief. Pain interfering with daily activities was also less common in people taking ibuprofen than in those taking acetaminophen. Ibuprofen shares the same side effects as naproxen, with little or no difference in the frequency or severity of side effects between the 2 medications.

Acetylsalicylic Acid

ASA (Aspirin) is the oldest over-the-counter NSAID. Like naproxen and ibuprofen, ASA is generally effective in reducing inflammation, pain and fever. ASA tends to cause more stomach irritation than naproxen and ibuprofen. This can be reduced by taking a coated form of ASA (Enteric-coated Aspirin, Aspirin EC).

Bleeding -- from the stomach or elsewhere -- may be more common with ASA, as it may interfere with platelet function more than naproxen and ibuprofen. As well, the clotting impairment lasts longer -- 7 to 10 days after taking ASA but only about 1 day after the other NSAIDs, according to the medical textbook “Bonica’s Management of Pain.” ASA's effects on clotting are useful for preventing heart attacks or strokes 4. When used for this purpose, the dose of ASA is limited to only 1 pill -- usually low-dose, “baby" aspirin -- per day.

Warnings and Precautions

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Although over-the-counter NSAIDs are quite similar, ask your doctor which is most appropriate for you. Take all over-the-counter medications as directed by the package instructions unless your doctor recommends otherwise. Also do not begin any NSAID if you are already taking another NSAID unless approved by your doctor. Even if you are taking only preventive low-dose ASA, do not take any naproxen or ibuprofen without your doctor's approval.

According to the US Food and Drug Administration-approved drug label, ASA should not be taken by children or teenagers with chickenpox or flu-like symptoms 6. In these situations, ASA may cause Reye syndrome -- a rare but potentially fatal condition. Behavior changes with nausea or vomiting are early signs of this syndrome.

See your doctor if you notice any new symptoms after taking an NSAID. Seek immediate medical care if you notice symptoms suggestive of stomach side effects, such as abdominal pain, nausea, vomit that is bloody or looks like coffee grounds, or stools that look like tar. Also obtain immediate medical help if you have symptoms suggestive of a heart attack or stroke, such as chest pain, shortness of breath, dizziness or lightheadedness, weakness, slurred speech or vision changes.

Reviewed and revised by Mary D. Daley, M.D.