Non-steroidal anti-inflammatory drugs (NSAIDs) are mainly used to treat pain and inflammation caused by injury, or by conditions such as gout, rheumatoid arthritis, osteoarthritis, headache, dental pain and period pain. NSAIDs have several side effects and may not be suitable for people who are pregnant or people with stomach problems, asthma, heart, liver or kidney problems. Before taking NSAIDs, check with your healthcare provider if they are suitable for you. Read more about when you should NOT take NSAIDs.
Many NSAIDs can be bought from your pharmacy without a prescription and some, such as ibuprofen, can be bought from the supermarket. NSAIDs are also available on prescription.
NSAIDs are usually available as tablets or capsules, some are available as a syrup and some are available as gels or creams that can be massaged into the painful area.
Aspirin is also an NSAID, but it is mainly prescribed in low doses to help to keep the blood from clotting, eg, for people who have had a heart attack in the past. Low dose aspirin is also called Aspec® or Cartia®.
How to take NSAIDs safely
Take them with food or immediately after food, to prevent stomach upset.
Use the lowest dose for the shortest time to provide pain relief.
Don't take more than the recommended dose and don't use over-the-counter NSAIDs for longer than 2 to 3 days without checking if it is safe with your healthcare provider.
Don't take more than 1 type of NSAID at a time. Some other medicines also contain NSAIDs, including some cold and flu preparations, so always read the label or ask your pharmacist.
Tell your healthcare provider about all the medicines you are taking before you buy any type of pain relief.
Before taking NSAIDs, check with your healthcare provider that they're right for you.
How long do NSAIDs take to work?
Depending on the NSAID and the condition being treated, some may work within an hour or two, but with others it could take more time before you feel the full benefit. NSAIDs that are used short-term may need to be taken every 4 to 6 hours because of their short action time. For osteoarthritis and rheumatoid arthritis needing long-term treatment, long-acting NSAIDs that only need to be taken once or twice a day may be used.
When is taking NSAIDs a concern?
NSAIDs are safe for most people but extra care is needed in some situations. Examples include if:
you have high blood pressure
you have heart or kidney problems or asthma
you're aged 65 years or older
The main risks of NSAIDs are how they affect your stomach, heart and kidneys. Read more about the risks of NSAIDs.
When you should NOT take NSAIDs
NSAIDs should NOT be used in some situations as they can be harmful.
For example, if you:
have current or previous stomach problems such as ulcers or bleeding
have heart failure or chest pain (angina)
have had a stroke or heart attack
have chronic kidney disease
have had an allergic reaction (such as hives or trouble breathing) to ibuprofen, aspirin, or other similar medications (discuss with your healthcare provider)
are taking medicines to reduce blood clots (anticoagulants) such as warfarin, dabigatran and rivaroxaban
are also taking other anti-inflammatory medicines, eg, diclofenac (Voltaren®), naproxen (Naprosyn®) or celecoxib (Celebrex)
are taking some blood pressure medicines such as ACE inhibitors, ARBs, diuretics. Always check with your healthcare provider before taking NSAIDs.
NSAIDs are often used for pain relief and can generally be safely used, but they may cause harm in some people. Before you use these medicines, weigh the risks and other side effects carefully – check with your pharmacist or doctor if they are suitable for you.
NSAIDs sometimes cause the lining of the stomach to bleed. This is because the chemicals (prostaglandins) that are reduced by anti-inflammatories are also involved in helping to protect the lining of the stomach from the effects of the acid within the stomach.
Stomach problems can occur in anybody taking NSAIDs, but you are more likely to have them if you:
have had stomach ulcers before
are 60 years or older
drink 3 or more alcoholic drinks a day
take warfarin, steroids (prednisone), SSRIs (citalopram, fluoxetine, paroxetine, sertraline) or more than one NSAID such as an NSAID plus low-dose aspirin
take NSAIDs regularly
take higher doses of NSAIDs.
Ulcers and stomach bleeding can happen without any warning symptoms.
Effects on the heart
Studies have shown that all NSAIDs, except aspirin in low doses, can increase the chance of heart attack or stroke.
The risk may be greater if you have heart disease or you have risk factors for heart disease such as smoking, high blood pressure, high cholesterol, diabetes. However, the risk may also be increased in people who do not have heart disease or those risk factors.
Heart problems caused by NSAIDs can happen within the first weeks of use and may happen more often with higher doses or with long-term use.
NSAIDs should not be used right before or after heart bypass surgery.
Effects on the kidneys
All NSAIDs, including selective COX-2 inhibitors, can reduce blood flow to the kidneys and affect the way your kidneys work. You're more likely to have kidney problems with NSAIDs if you:
are 60 years or older
already have problems with your kidneys
are taking other medicines that also affect your kidneys such as ACE inhibitors ARBs, or diuretics.
Examples of ACE inhibitors are captopril, cilazapril, enalapril, lisinopril, perindopril and quinapril. Examples of ARB blockers are candesartan and losartan. Examples of diuretics are furosemide, bumetanide, bendroflumethiazide, chlortalidone, indapamide and metolazone. Taking NSAIDs together with ACE inhibitors or ARBs and diuretics is called the triple whammy. Read more about the harmful effects of the triple whammy.
Effects on blood pressure
NSAIDs can raise blood pressure in some people. Some people with high blood pressure (hypertension) may have to stop taking NSAIDs, if they notice that their blood pressure increases even if they are taking their blood pressure medications and following their diet. If you are taking blood pressure medication, talk to your healthcare provider before taking NSAIDs.
Effects on asthma
NSAIDs can cause symptoms of asthma to worsen such as cough, wheezing, shortness of breath. Talk to your healthcare provider before taking NSAIDs if you have asthma.
Effects on pregnancy
NSAIDs may increase the risk of miscarriage if used in early pregnancy. NSAIDs should also be avoided during the third trimester because they may affect the large blood vessels of the developing baby. It is generally recommended to avoid the use of NSAIDs during pregnancy unless the benefit justifies the risk.
The following links provide further information about ibuprofen. Be aware that websites from other countries may have information that differs from New Zealand recommendations.