How to Take NSAIDs Safely

NSAID stands for non-steroidal anti-inflammatory drug. NSAIDs are widely used to treat mild to moderate pain, fever, and swelling. This makes them useful for pain relief from headaches, sports injuries, arthritis, and rheumatic diseases.

These drugs are common and probably on your medicine shelf at home. But, this does not mean they are without risk. Understanding how NSAIDs work, how they should be used, and their side effects can help keep you safe when taking these common pain killers.

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 steroids, which are prescription medicines that mimic the body’s natural hormones. Steroids (also called corticosteroids) suppress your immune system, which reduces inflammation. But, NSAIDs come with more side effects than acetaminophen, which is a different type of pain reliever.¹

How are NSAIDs used?

NSAIDs can be effective pain relievers when used as directed. Over-the-counter NSAIDs are best for short-term pain relief. If you use them for longer-term conditions like type 2 diabetes, your doctor should monitor you for side effects. Short-term use is generally considered 3 days for fever or 10 days for pain. You should not use an NSAID for longer without talking to your doctor.¹

Types of NSAIDS

NSAIDs are a large group of drugs that come in over-the-counter and prescription forms.^1-4

Over-the-counter NSAIDs include:

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

Prescription NSAIDs include:

• Celecoxib (Celebrex^®)
• Diclofenac (Voltaren^® [available by brand name in topical form])
• Diflunisal
• Etodolac
• Fenoprofen (Nalfon^®)
• Flurbiprofen
• Ibuprofen (stronger than over-the-counter versions)
• Indomethacin (Indocin^® [available by brand name in liquid form])
• Ketoprofen
• Ketorolac (Acular^®, Sprix^®, and Toradol^®)
• Meclofenamate sodium
• Mefenamic acid (Ponstel^®)
• Meloxicam (Mobic^®)
• Nabumetone
• Naproxen sodium (Anaprox^®, Naprosyn^®)
• Oxaprozin (Daypro^®)
• Tolmetin
• Salsalate (Disalcid^®)

To relieve longer-term pain or chronic pain, your doctor may suggest you take a prescription NSAID. These medicines help relieve pain when they are taken 1 time to 2 times a day. Unlike over-the-counter NSAIDs, which begin to work right away, prescription NSAIDs may take 1 to 2 weeks to start relieving pain.^1,2

You may need to try a few NSAIDs to find the right one for you.¹

Possible side effects

Side effects of taking NSAIDs usually occur when taking large doses for a short time or smaller doses for a long time. The most common side effects happen in the gut and include:¹

• Gas
• Feeling bloated
• Heartburn
• Stomach pain
• Nausea and vomiting
• Diarrhea or constipation

Your doctor may suggest taking the drug with food, milk, or an antacid. If the side effects do not go away after a few days, your doctor may suggest a different NSAID.¹

These are not all the possible side effects of taking an NSAID. You also should call your doctor if you have any changes that concern you when taking NSAIDs.

NSAIDs may affect heart health

Because NSAIDs can cause serious side effects, it is important to see your doctor on a regular basis if you take these drugs long-term. This allows them to watch you for any dangerous side effects. Your doctor may also order blood tests or kidney function tests. These tests help track how well the drugs are working and any serious side effects.¹

Serious side effects include:
Heart disease and stroke. Using NSAIDs long-term has been linked to an increased risk of heart disease, stroke, and higher blood pressure. The risk is highest in people who already have heart disease, diabetes, or high cholesterol. But, even people who take these drugs for a short time have an increased risk of this side effect.²

Stomach problems. Long-term use 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.¹

Kidney disease. Long-term use of NSAIDs can also cause kidney problems. This is more common in people who already have kidney disease.³

Serious side effects may be highest in:¹

• Older people
• Those who have more than 3 alcoholic drinks a day
• Those who take more than 1 NSAID at the same time

How to take NSAIDS safely

To reduce the risk of side effects or other problems caused by NSAIDs, it is important to take only the recommended amount for as short amount of time as possible..^1,2

Listen to your doctor’s advice about how long and how much painkiller to take. You may not be able to take these drugs if you have heart disease, kidney disease, stomach ulcers, or you are taking blood thinners.

Other options for pain control

You may find you can reduce your need for NSAIDs using other pain relief techniques. Some common options include:⁵

• Acupuncture
• Biofeedback
• Cold packs
• Warm baths
• Physical therapy
• Gentle exercise like yoga or tai chi
• Weight loss
• Massage
• Joint-supporting splints

Some people try acetaminophen (Tylenol^®) because it has fewer side effects. However, some people find it is not as effective as NSAIDs. Still, your doctor may recommend an NSAID holiday where you take acetaminophen for a week. Remember, all drugs have side effects, and this is also true for acetaminophen.²

Before beginning treatment for type 2 diabetes, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.