Nonsteroidal anti-inflammatory medications, known as NSAIDs, are widely and often successfully used to ease back and neck pain, however, they do have some drawbacks. Some people may experience serious side effects, including cardiovascular, gastrointestinal, and kidney problems.
Risks and complications are typically greater for people who take NSAIDs for a long period—daily use for weeks, months or even years. The U.S. Food and Drug Administration recommends people taking an over-the-counter NSAID for more than 10 days see a doctor, and that NSAIDs be used in the smallest effective dose for the shortest possible time.1
- Can develop as soon as the first weeks of NSAID use
- Is most serious for people who have experienced a heart attack, have other heart problems or have risk factors for heart events
- Appears to be most significant with higher doses of medication
Research into NSAIDs’ risks includes an analysis of multiple studies. There were several important findings from the analysis:
- The risk of heart attack or stroke was raised by one-third when high doses of the NSAID diclofenac were taken.3
- The risk was similar with celecoxib (Celebrex) and ibuprofen (Advil, Motrin).3
- Naproxen (Aleve, Naprosyn) did not show an increase in heart attacks or stroke.3
- he risk of heart failure doubled with all four NSAIDs studied—diclofenac, ibuprofen, celecoxib, and naproxen.
Both ibuprofen and naproxen can cause additional cardiovascular problems. They thin the blood, and too much blood thinning may lead to bleeding. Because of this thinning effect, individuals taking oral blood thinners or anticoagulants should avoid ibuprofen and naproxen. Ibuprofen and naproxen also can reduce the effectiveness of some blood pressure medications and diuretics (water pills).
Some research points to an even greater risk of cardiovascular problems with celecoxib (Celebrex).3
The FDA does not consider any type of NSAID to be riskier than another, but the American Heart Association advises people already at risk for cardiovascular events to only use celecoxib if there are no better alternatives.4 The American Heart Association further recommends that individuals using celecoxib should have their blood pressure and kidney function monitored as a precaution.
Stopping NSAIDs Suddenly Poses Heart-Related Risks
Despite the risks associated with taking NSAIDs daily, people who have been taking NSAIDs daily for long periods of time should not stop taking them abruptly.
The body’s reaction to such a cutoff could make blood clots more likely, adding to the risk of heart attack or stroke. Instead, a person who is regularly using NSAIDs should talk with a doctor about the best way to taper off.
Risk of Stomach Problems
Individuals with ulcers or sensitive stomachs are advised to avoid NSAIDs because of the risk of bleeding in the gastrointestinal tract, including the stomach.
People older than 65 and those taking blood thinners or corticosteroids are particularly at risk of gastrointestinal problems. These problems include:
- Upset stomach
- Stomach bleeding
Drinking alcohol can increase the risk of stomach problems.
It is recommended that anyone using oral NSAIDs take them with food. A doctor and/or pharmacist may recommend adding another medication to protect the stomach when taking NSAIDs.
Risks of Kidney Damage
This increased risk exists because NSAIDs can reduce the amount of blood reaching the kidneys, slowing kidney function. Water and salt retention, high blood pressure, and electrolyte imbalances have been linked to NSAIDs’ effect on the kidneys. In rare cases, kidney failure can result.
Individuals whose kidney function is impaired should not take NSAIDs without consulting a doctor.
Allergic Reactions to NSAIDs
As with other medications, there is a risk of allergic reaction. Signs of allergic reaction include:
- Swelling in the face
- Hives or a skin rash
- Reddened face
Anyone having trouble breathing should go to an emergency room immediately. The doctor should be advised of any reactions or side effects, even if they do not appear serious.
Additional Safety Concerns
People with chronic conditions and those who are pregnant or breastfeeding are advised to discuss their medical history and current status with a doctor before taking NSAIDs.
The FDA’s pregnancy safety ranking for medications runs from A through X, with A being the safest. As a class, NSAIDs are pregnancy category C, however celecoxib, diclofenac, fenoprofen, ibuprofen injection, indomethacin (Tivorbex only), and meloxicam (starting at 30 weeks’ gestation) are pregnancy category D.
This is not a comprehensive list of potential risks and complications associated with NSAIDs. Anyone taking NSAIDs should consult their treating physician and/or pharmacist regarding their individual situation.