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How to Take NSAIDs Safely

NSAID stands for non-steroidal anti-inflammatory drug. NSAIDs generally work well to treat mild to moderate pain and swelling. This makes them useful for pain from arthritis and other rheumatic diseases such as ankylosing spondylitis.

Types of NSAIDS

NSAIDs are a class, or category, of medication. There are multiple individual medicines within this class. Some are available over-the-counter and some require a prescription.

Over-the-counter NSAIDs include:

  • Aspirin (such as Anacin®, Ascriptin®, Bayer®, Bufferin® and Excedrin®)
  • Ibuprofen (such as Motrin® and Advil®)
  • Naproxen sodium (such as Aleve®)

Prescription NSAIDs include:

  • Celecoxib (Celebrex®)
  • Diclofenac (Voltaren® [available by brand name in topical form])
  • Diflunisal
  • Etodolac
  • Fenoprofen (Nalfon®)
  • Flurbiprofen
  • Ibuprofen
  • Indomethacin (Indocin® [available by brand name in liquid form])
  • Ketoprofen
  • Ketorolac tromethamine
  • Meclofenamate sodium
  • Mefenamic acid (Ponstel®)
  • Meloxicam (Mobic®)
  • Nabumetone
  • Naproxen sodium (Anaprox®, Naprosyn®)
  • Oxaprozin (Daypro®)
  • Piroxicam (Feldene®)
  • Sulindac
  • Tolmetin
  • Salicylate
  • Salsalate (Disalcid®)

How do NSAIDs work?

NSAIDs block the production of certain chemical signals in the body that cause pain and inflammation. They have fewer side effects than corticosteroids, which are prescription medications that mimic the body’s natural hormones. Corticosteroids (also called steroids) can also suppress your immune system.1

How are NSAIDs used?

NSAIDs can be effective pain relievers when used as instructed. Over-the-counter NSAIDs are best used for short-term pain relief. If you use them for longer-term conditions, your doctor should monitor you for side-effects. Short-term use is generally considered three days for fever or 10 days for pain.1

To relieve longer-term pain or chronic pain, like that caused by osteoarthritis, ankylosing spondylitis, and other chronic arthritic or musculoskeletal diseases, doctors might recommend prescription NSAIDs. These medicines are effective when they are taken one time to four times per day. Unlike over-the-counter NSAIDs, which start working right away, prescription NSAIDs might take one to two weeks to start relieving pain.1

What are some dangers of NSAIDs?

Because NSAIDs can have serious side-effects, it is important for you to meet with your healthcare provider on a regular basis, so you can be watched for any problems that might arise. Your doctor might also want to order blood tests or kidney function tests to be sure the medicines are effective and that you are not experiencing serious side-effects.1

Serious side-effects can include:

  • Stomach problems. Overuse of NSAIDs can cause stomach issues, including ulcers and bleeding. The risk is higher for people over 60 as well as for those who take prescription blood thinners or steroids. People who already have ulcers or stomach bleeding are at higher risk, as well.4
  • Kidney disease. Long-term use of NSAIDs can also cause kidney problems, especially among people over 60. They are also more common for people who already have kidney disease, are taking medicines that increase urine production or who have high blood pressure or heart disease.4
  • Heart disease and stroke. Overuse of NSAIDs has also been linked to an increased risk of heart disease and stroke. Naproxen is the least likely to cause heart problems.

How to take NSAIDS safely

To reduce the risk of side-effects or other problems caused by NSAIDs, it is important to take as little medication as possible for as short as possible.5 Listen to your doctor’s advice about how long and how much medication to take. Also, do not take these medications if you already have risk factors, like kidney disease, stomach ulcers, or you are taking blood thinners.

To reduce stomach problems, you can take medicines that limit acid production, such as omeprazole (Prilosec®). Eating a healthy diet and engaging in regular exercise can decrease your risk of heart problems.5

Other options

You can also try to use other methods of pain relief, including acupuncture, biofeedback, yoga, or using heat and cold therapy.5 These can reduce your reliance on NSAIDs for pain relief.

  1. Non-Steroidal Anti-Inflammatory Medicines (NSAIDs). The Cleveland Clinic. Updated April 27, 2016. Available at: https://my.clevelandclinic.org/health/drugs/11086-non-steroidal-anti-inflammatory-medicines-nsaids Accessed April 11, 2019.
  2. Chronic pain: Medication decisions. The Mayo Clinic. Updated February 14, 2018. Available at https://www.mayoclinic.org/chronic-pain-medication-decisions/art-20360371 Accessed April 11, 2019.
  3. Prednisone and other corticosteroids. The Mayo Clinic. Updated November 15, 2018. Available at: https://www.mayoclinic.org/steroids/art-20045692 Accessed April 11, 2019.
  4. A Guide to Safe Use of Pain Medicine. US Food and Drug Administration. Last updated December 12, 2018. Available at: https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm095673.htm Accessed April 11, 2019.
  5. Pain relief: Taking NSAIDs safely. Harvard Health Publishing. Harvard Medical School. September 2013. Available at: https://www.health.harvard.edu/pain/pain-relief-taking-nsaids-safely Accessed April 11, 2019.

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