Nonsteroidal anti-inflammatory drugs (NSAIDs) are a group of medications used to reduce inflammation, pain, and fever. They’re among the
NSAIDs are available over the counter (OTC) and by prescription. Prescription NSAIDs are stronger in dose than the OTC versions.
First, let’s look at how two types of NSAIDs work to know the kinds of side effects they can have.
NSAIDs work by blocking your body’s production of the chemicals associated with pain and inflammation. NSAIDs block enzymes called cyclooxygenases (COX). There are two forms of COX:
- COX-1 protects the stomach lining and aids kidney function.
- COX-2 is produced when joints are injured or inflamed.
Some NSAIDs work to block both forms of COX. These are called nonselective NSAIDs. They include aspirin, ibuprofen, and naproxen. Because they block both forms of COX, they may have the side effect of stomach irritation.
Other, newer NSAIDs only block COX-2. These are called selective NSAIDs. They include celecoxib (Celebrex). They’re thought to be less likely to cause stomach problems.
NSAIDs, like other drugs, have the risk of side effects. Older people and those with some chronic illnesses may have increased risk for side effects from NSAIDs.
Most people tolerate NSAIDs well. Mild side effects may be countered by lowering the NSAID dose, or taking an additional drug to counter the side effect.
Here are some of the possible side effects:
Stomach problems are the most common side effect of NSAIDs. These include:
- irritation or pain
- diarrhea or constipation
- bleeding and ulcers
You can lessen stomach side effects by taking NSAIDs with food, milk, or a drug that blocks acid production (antacid).
Drinking alcohol when taking NSAIDs can increase your risk for internal bleeding.
NSAIDs that release nitric oxide are under development. They’re thought to be able to reduce stomach problems.
Heart attack and stroke
Except for aspirin, NSAIDs can increase your risk for high blood pressure, stroke, or heart attack.
In July 2015, the
The warning on all NSAID labels notes that the increased risk can occur in the first weeks of NSAID use. The risk may increase if you use NSAIDs longer. There’s also more likely risk at higher doses.
The FDA warning also says this risk occurs whether or not you have other risk factors for heart disease and stroke.
Increased blood pressure
NSAIDs may also reduce the effect of some blood pressure medications.
On average, NSAIDs can increase blood pressure by
The most common NSAID kidney problem is fluid retention, like swollen ankles and feet. Other kidney problems are less common.
According to the National Kidney Foundation, NSAIDs may cause an increased risk of sudden kidney failure or kidney damage.
The foundation advises that if you already have decreased kidney function, you should avoid NSAIDs.
Allergic reactions to NSAIDs are rare.
If you have symptoms of a generalized allergic reaction, seek emergency medical care.
- swollen lips, tongue, or eyes
- shortness of breath, wheezing
- difficulty swallowing
- rash or hives
Bruising or bleeding
NSAIDs can reduce your blood’s ability to clot. This may cause you to bruise more easily. Small cuts may take longer to stop bleeding.
The effect can be serious if you also take blood thinners like warfarin (Coumadin).
Other side effects
Some people may experience:
- balance problems
- trouble concentrating
Fast facts about NSAIDs
- NSAIDs make up
5 to 10 percentof all medications prescribed each year.
40 percent of people65 years and older fill one or more prescriptions for an NSAID every year.
- About 60 million NSAID prescriptions are written each year.
- NSAIDs cause an estimated
41,000 hospitalizations and 3,300 deathseach year among older adults.
Consult your doctor if you have any new symptoms when taking NSAIDs. You may need to adjust the dose or switch to another medication.
Red flag symptoms include:
- allergic reaction, such as itching, rash, or swelling
- unexplained weight gain
- black stools
- blurry vision
- sensitivity to light
- trouble urinating
- bad headache or other pain
- pain in the middle of your back
If you have more severe symptoms, get emergency help.
Get urgent help for:
- trouble breathing
- chest pain
- weakness on one part of your body
- swelling of your face or throat
- slurred speech
The Cleveland Clinic advises that you not use an OTC NSAID for more than three days for fever and 10 days for pain. When taking an NSAID for a longer time, your doctor should monitor you.
Long-term use of NSAIDs has greater risk of potential side effects, especially for older people.
- peptic ulcers
- renal failure
- stroke and heart disease
Chronic NSAID use also
NSAID drugs purchased OTC and prescription NSAIDs have recommended dose levels and durations printed on the label. But a
A 2016 review of many NSAID studies found that stomach ulcers, bleeding, or perforation occurred in about 1 percent of people taking NSAIDs for three to six months. The percentages increased to between 2 and 4 percent for people taking NSAIDs for a year.
The same study noted that long-term NSAID use resulted in kidney damage and eye damage. As a precaution, this study advised that people using NSAIDs long term should have periodic blood tests to monitor changes.
If you have to take NSAIDs every day for chronic pain, there may be other drugs you can take to lessen the side effects of NSAIDs. Discuss this with your doctor.
Reactions to NSAIDs vary by individual. The way NSAIDs work also varies. You may have to try different types of NSAIDs to find one that works well for you.
Children and teens who have viral infections shouldn’t take aspirin or drugs containing aspirin, because there’s a risk of the potentially fatal Reye’s syndrome.
If you have a health condition that affects your heart, liver, or kidneys. discuss alternatives to NSAIDs with a doctor.
If you’re pregnant, discuss the possible effects of NSAIDs on the fetus after 30 weeks.
Be aware that alcohol may exacerbate the side effects of NSAIDs, especially stomach bleeding.
NSAIDs are one of the common causes of adverse drug interactions.
NSAIDs shouldn’t be mixed with other NSAIDs. The exception to this is combining a low-dose aspirin with another NSAID for heart attack and stroke prevention. Discuss this with your doctor.
NSAIDs aregrouped by their chemical characteristics, selectivity, and half-life. The NSAIDs in use today are formulated from either:
- acetic acid
- anthranilic acid
- enolic acid
- propionic acid
Here are some commonly used NSAIDs:
- aspirin compounds, including:
- ibuprofen, including:
- naproxen sodium, including:
- celecoxib (Celebrex)
- diclofenac (Voltaren)
- fenoprofen (Nalfon)
- indomethacin (Indocin)
- ketorolac tromethamine
- meclofenamate sodium
- mefenamic acid (Ponstel)
- meloxicam (Mobic)
- naproxen sodium (Anaprox, Naprosyn)
- oxaprozin (Daypro)
- piroxicam (Feldene)
- salsalate (Disalcid)
Some NSAIDs work quickly, within a few hours. Others take longer, sometimes one or two weeks, to build up to an effective blood level of the drug.
Some NSAIDs are available in slow-release form or as a patch or gel. Other drug-delivery systems are being researched.
It’s important to take the full dose every day. Otherwise, you won’t know if the particular drug is helping you.
It’s equally important that you don’t take more than the dose your doctor prescribes. Doing so may increase your risk for side effects without any added benefit.
NSAIDs can bring relief, especially if you have chronic pain. But like all drugs, the benefits come with some risks. With NSAIDs, stomach problems are the most common side effect.
If your side effects are mild, you may be able to take another drug to lessen the effects. If NSAIDs aren’t appropriate for you, there are likely to be other treatment options.
People with heart, kidney, or digestive conditions, and older people in general, are more likely to have a risk for side effects.
In general, discuss any diseases and all your medications and supplements with your doctor to rule out any possible adverse reactions with NSAIDs.
NSAIDs are very commonly used and well researched, so it’s likely that there’ll be new drug and treatment options in the future.