NSAIDs, short for non-steroidal anti-inflammatory drugs, are among the most commonly used medications in the United States. Available in prescription strength and over-the-counter, NSAIDs reduce inflammation and pain by interfering with your body’s production of chemicals called prostaglandins. Some of the most commonly used NSAIDs include aspirin, ibuprofen, naproxen, ketoprofen and celecoxib. Although effective for a variety of conditions, ranging from arthritis to headaches, taking too many NSAIDs may increase your risk of serious medical problems, some of which may be life-threatening.
As with any medication, there are a number of potential risks, side effects, and complications that it patients need to be aware of prior to starting to take the any form of the medication. Potential risks and complications of NSAID ingestion include:
- Kidney damage. NSAIDs are cleared from the blood stream by the kidney, so it is very important that patients over 65 years of age or patients with kidney disease consult a physician prior to taking the medication. If patients take an NSAID for an extended period of time (e.g. six months or more), a blood test needs to be performed to check for early signs of kidney damage. Taking too many NSAIDs can cause sudden kidney failure or chronic kidney disease. With acute kidney failure, discontinuation of the offending NSAID usually leads to recovery of kidney function. A more subtle form of chronic kidney disease called chronic interstitial nephritis can develop if you take NSAIDs regularly for many years. This condition most often occurs in people taking high doses of NSAIDs for chronic pain. NSAIDs are particularly dangerous if you have preexisting kidney disease
- Ulcers. NSAIDs are a common cause of ulcers, also known as peptic ulcer disease. Your stomach is the most likely site for an NSAID-induced ulcer to develop. Less commonly, the first part of your intestine, called the duodenum, may be affected. Your risk of developing an NSAID-related ulcer depends on how often you take NSAIDs, the dosage, how long you have been taking NSAIDs and whether you have other risk factors for peptic ulcer disease. Heavy alcohol use, smoking, taking a combination of NSAIDs and a past history of ulcers increase your risk of developing an NSAID-induced ulcer. Symptoms you may experience with a peptic ulcer include dull or burning pain in your upper abdomen when your stomach is empty, reduced appetite, frequent belching, bloating, nausea and vomiting.
- Gastrointestinal bleeding. An ulcer caused by NSAID use may erode into a blood vessel in your stomach or intestine, leading to gastrointestinal bleeding. Symptoms and signs to look for include sharp, persistent stomach pain, vomiting blood and black stools. With prolonged or severe bleeding, you may develop weakness, paleness and loss of energy. Importantly, gastrointestinal bleeding may not cause obvious signs or symptoms. Take NSAIDs in the lowest, effective dose possible and limit the length of time you take them to reduce your risk of gastrointestinal bleeding. Talk with your doctor if you take NSAIDs for a chronic condition, such as arthritis, to determine the safest option for you.
- Heart attack and stroke. NSAIDs may increase your risk of having a heart attack or stroke, especially if you have pre-existing heart disease. These drugs may increase your blood pressure and contribute to the progression of atherosclerosis, a condition in which your arteries become clogged and blood flow to your heart and brain are reduced. In a January 2011 article published in the medical journal “BMJ,” Drs. Sven Trelle and colleagues report that all NSAIDs increase the risk of heart attack and stroke, including ibuprofen. The U.S. Food and Drug Administration requires that all prescription NSAIDs carry a warning about the potential for increased risk of heart attack, stroke and gastrointestinal bleeding associated with use of these drugs.
- Delayed healing. Inflammation is a necessary component in the healing process, decreasing inflammation may prove counterproductive. the body responds to injury with a sequence of events that begins with an influx of inflammatory cells and blood. The inflammatory cells remove debris and recruit cytokines and other growth factors toward the injury site. This inflammatory phase is partly mediated by the same prostaglandins that are blocked by NSAIDs. In a healthy healing process, a proliferative phase consisting of a mixture of inflammatory cells and fibroblasts naturally follows the inflammatory phase. The fibroblasts build a new extracellular matrix and persist into the final phase of repair, the maturation phase, where, if all goes well, functional tissue is laid down. The key point is that each phase of repair is necessary for the subsequent phase. By blocking the inflammatory phase, NSAIDs can, at least theoretically, delay the healing of musculoskeletal injuries.
Most types of NSAIDs have a variety of other potential risks and complications associated with them. While most side effects are rare, some can be serious and even potentially fatal, so it is important for patients to remain aware of them and under supervision by a health professional.
As a general rule, patients with any of the following factors should be sure to meet with their doctor before taking any type of NSAID:
- Thyroid problems
- Heart disease
- High blood pressure
- Allergy or reaction to aspirin, other NSAIDs or pain relievers
- Pregnant, about to become pregnant, or breast feeding
- Consume three or more alcoholic beverages a day
- About to have surgery or other invasive procedures (including dental surgery)
In order to ensure that NSAIDs are used safely, patients should meet with a physician to evaluate their individual risk factors (e.g. the patient’s likelihood for developing certain health problems, including heart attack, stroke, and gastrointestinal problems) and to determine the most appropriate dosages, type of NSAID, and treatment options.
In general, it is recommended that patients avoid taking over-the-counter NSAIDs for more than 10 days in a row without consulting their physician.
As with all medications, patients should discuss with their doctor medications taken (including herbal remedies, supplements, etc), all other medical conditions and allergies. Patients should strictly follow label directions for all pain medications, including non-prescription medications.