Risks associated with taking NSAIDs

Non-steroidal anti-inflammatories drugs (NSAIDs)

Most people have no problem taking anti-inflammatories, but some people are seriously harmed by these medicines, especially taking them long-term. Learn more about the risks of taking NSAIDs.

NSAIDs are often used for pain relief and can generally be safely used, but they may cause harm in some people.

Examples of commonly used NSAIDs include ibuprofen (Ibugesic®, I-Profen®, Nurofen®), diclofenac (Voltaren®), naproxen (Noflam®, Naprosyn®), celecoxib (Celebrex®) and mefenamic acid (Ponstan®). See which NSAIDs are available in New Zealand.  

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. 

The main risks of NSAIDs include its effects on:

Effects on the stomach

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
  • smoke
  • 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 dehydrated
  • 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 (trimester 1 and 2). It is recommended to avoid the use of NSAIDs during early pregnancy unless the benefit justifies the risk.

Don't use NSAIDs at all during the third trimester because they may affect the large blood vessels and cause serious kidney problems in the unborn baby. NSAIDs can cause delay in labour and lead to problems during birth such as excessive bleeding. 

Learn more

The following links provide further information about ibuprofen. Be aware that websites from other countries may have information that differs from New Zealand recommendations.

Anti-inflammatory painkillers Patient info, UK
The triple whammy SafeRx, Waitematā DHB, NZ

Credits: Health Navigator Pharmacists.