How to use NSAIDs Safely

Published: September 02, 2021
By Gaelle Njonkou, Pharm.D.
By Sheheryar Muhammad, Pharm.D., BCPS, CACP

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to relieve pain associated with headaches, arthritis, menstrual cramps, cold, flu, and to reduce fever. They work by stopping the body's production of a substance that causes pain, fever, and inflammation. Over-the-counter (OTC) NSAIDs containing ibuprofen such as Advil or Motrin, and naproxen such as Aleve, are available under various brand names and may be used by adults and children. NSAIDs generally can be used for short-term pain relief, but they do have risks associated with use, especially if used for a long period of time.

What are some side effects of NSAIDs?
When suffering from fever and pain, we rely on easily available OTC NSAIDs, but they do have potential side effects. Side effects of NSAIDs could vary depending on the dose, how long you use them, and your condition.

Common side effects include stomach pain, nausea, diarrhea, vomiting, constipation, dizziness, headache, rash, or decreased appetite. More severe and less common side effects include bleeding, fluid building up in the body, or new or worsening kidney or liver problems. Additionally, NSAIDs can cause an increase in blood pressure. NSAIDs, except for aspirin, can increase the risk of heart attack, heart failure, or stroke.

Which medications interact with NSAIDs?
NSAIDs are often used in addition to other medications you are already taking. However, there may be a risk of an interaction. The effect from the interactions may depend on the dose and how long you are taking the NSAID. If you are taking any of the following medications, check with your doctor before taking OTC NSAIDs:

  • Diuretics, also called “water pills”: Due to their effects on the kidneys, NSAIDs can reduce the action of diuretics
  • Lithium or methotrexate: These medications are eliminated by the kidneys and therefore could build up and increase the potential for side effects.
  • Blood pressure medications: When taken with NSAIDs, especially when taken regularly, can have a reduced effect.
  • Aspirin: If taking this to prevent a heart attack or stroke, NSAIDs can decrease the effect
  • Blood thinners, such as warfarin can increase the risk of bleeding
  • SSRI antidepressant medications, such as fluoxetine (Prozac) and sertraline (Zoloft), can increase the risk of gastrointestinal and other types of bleeding.

Who should talk to their pharmacist or doctor before taking NSAIDs?
You should talk with your doctor before using OTC NSAIDs if you have:

  • Allergies to aspirin and any NSAIDs
  • Kidney disease, heart failure, or liver disease
  • Stomach ulcers or bleeding problems
  • High blood pressure

You should also talk to your doctor or pharmacist before using NSAIDs if you are in any of the following groups:

  • Drink three or more alcoholic beverages per day
  •  60 years and older
  • Are pregnant. NSAIDs may harm the fetus and cause problems with delivery if it is taken around 20 weeks or later during pregnancy.
  • If you are undergoing a coronary artery bypass graft (a type of heart surgery), you should not take ibuprofen right before or after surgery.

What should you do to keep yourself safe while taking NSAIDs?

  • Use the lowest dose to treat your condition and take only for as long as needed or recommended by your doctor.
  • Take NSAIDs with food or milk to ease some of the gastrointestinal side effects.
  • Avoid drinking alcohol while taking NSAIDs to reduce risks of bleeding.

As always, check with your pharmacist or doctor if unsure about the risks associated with taking NSAIDs or if you have any questions about NSAIDs or any other medications.

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