NSAIDs: How safe are they?

Medically Reviewed by Jabeen Begum, MD on November 15, 2023
6 min read

NSAIDs, or nonsteroidal anti-inflammatory drugs, are medications that can relieve pain and reduce fever and inflammation. Doctors use NSAIDs to treat many conditions that cause pain, inflammation, or stiffness, such as arthritis headaches, andstrained or torn muscles.

NSAIDs can be bought over the counter or prescribed by a doctor. These anti-inflammatory medications come in several forms, including:

  • Caplets or tablets
  • Liquids (which work well if you are unable to swallow pills)
  • Creams or gels - are good for pain in small areas such as the shoulder or wrist and reduce heart risks and stomach upset you may have from NSAIDs
  • Injections - are usually given by your doctor for the management of short-term, moderate, or severe pain
  • Suppositories - can be used if you can't take medications by mouth

Over-the-counter anti-inflammatories (ones you can buy without a prescription) include:

Advil, Motrinibuprofen
Alevenaproxen sodium
Ascriptin, Bayer, Ecotrinaspirin

Never use an over-the-counter NSAID for more than 10 days without checking with your doctor. Over-the-counter NSAIDs are effective pain relievers, but they are intended for short-term use. With long-term use of NSAIDs, your doctor should closely monitor your progress so that they can watch for side effects and change your treatment if needed.

The following prescription anti-inflammatory drugs can be prescribed by your doctor:

Anaproxnaproxen sodium
Cambia, Cataflamdiclofenac potassium
Indocin, Tivorbexindomethacin
Mobic, Vivlodexmeloxicam
Naprelan, Naprosynnaproxen
Voltaren, Zorvolexdiclofenac
 ketorolac tromethamine

All prescription NSAIDs have a warning that the medications may increase the chance of having a heart attack, stroke, and stomach bleeding.

An enzyme in your body called cyclooxygenase (COX-2) creates chemicals that cause inflammation, fever, and pain. NSAIDs block you from producing this enzyme, which stops these conditions from happening.

All NSAIDs reduce pain and inflammation, but some may provide you more relief than others. Some NSAIDs also may be more convenient, as you only need to take them once or twice a day. Also, some NSAIDs may have fewer side effects than others. The effects differ from person to person.

NSAIDs can also interact with some medications. Talk to your doctor before taking NSAIDs if you are on:

  • Warfarin - used to prevent blood clots
  • Prescription NSAIDs
  • Selective serotonin reuptake inhibitors (SSRIs) that treat depression
  • Lithium - used to treat mental health conditions such as bipolar disorder
  • Diuretics - sometimes used to treat high blood pressure
  • Methotrexate - used to treat cancer and inflammatory conditions such as arthritis
  • Ciclosporin - used to treat autoimmune conditions such as ulcerative colitis


NSAIDs raise your risk of having a heart attack or stroke, especially in higher doses (when you take more than the recommended dose or what your doctor prescribes). They can also cause stomach bleeding.

NSAIDs are safest when you take them in low doses for brief periods. Side effects most commonly happen if you take large doses over a long time (months or years).

Some side effects are mild and go away on their own or after you reduce your dose. Others may be more serious and need medical attention.

Common side effects of NSAIDs include:

  • Stomach pain, heartburn, gas, bloating, nausea and vomiting, diarrhea, and constipation
  • Stomach ulcers
  • A tendency to bleed more, especially when taking aspirin. Your doctor might tell you to stop taking NSAIDs before surgery. Ask your doctor before taking NSAIDs if you are on a blood-thinner like Coumadin.
  • Headaches and dizziness
  • Feeling lightheaded
  • Ringing in the ears
  • Difficulty concentrating
  • Allergic reactions such as rashes, wheezing, and throat swelling
  • Liver or kidney problems. If you have kidney problems, you shouldn’t take NSAIDs without checking with your doctor.
  • High blood pressure
  • Leg swelling
  • Balance issues

Other side effects are less common. If your side effects are interfering with daily activities or last more than a few days, stop taking the NSAID and call your doctor. 


There is no way to avoid the side effects of any drug. But you and your doctor can lower your risk of having side effects from NSAIDs.

If you don't need 24-hour relief, avoid one-dose-a-day NSAIDs, especially if you are over 60 years old. These medications stay in your body longer and may cause more side effects.

If you are having stomach pain when taking NSAIDs, you can use acetaminophen as an alternative for pain relief, especially if your doctor feels that your condition does not require an anti-inflammatory drug. Take the smallest dose of NSAIDs that you need. Reduce or stop using alcohol (which can irritate your stomach) while taking NSAIDs. Take NSAIDs with food. You can also ask your doctor about taking a second drug, such as an acid blocker, that can reduce your risk of stomach ulcers and bleeding. Some medications combine an NSAID and an acid blocker in one pill.

If you have lasting or unusual pain in your stomach after starting an anti-inflammatory medication, tell your doctor right away.

Anyone can get a stomach ulcer while taking NSAIDs. But it may be more likely if you:

  • Are over 65 years old
  • Smoke
  • Just started taking NSAIDs daily
  • Have a history of stomach ulcers or stomach bleeding
  • Drink three or more alcoholic drinks daily
  • Take anti-inflammatory steroids, such as prednisone
  • Have kidney failure

Doctors prescribe NSAIDs in different doses depending on your condition.

Dosages may range from one to four times per day, depending on how long the drug stays in your body. Your doctor may prescribe higher doses of NSAIDs if you have rheumatoid arthritis (RA), for example, because often there is a lot of heat, swelling, redness, and stiffness in the joints with RA.

Lower doses may be enough for osteoarthritis and muscle injuries, as there is generally less swelling and often no warmth or redness in the joints.

No single NSAID is guaranteed to work. Your doctor may prescribe several types of NSAIDs before finding one that works best for you.

NSAIDs can raise blood pressure in some people. You may have to stop taking NSAIDs if your blood pressure goes up even though you regularly take your blood pressure medications.

Ask your doctor before taking an NSAID if:

  • You have had serious side effects from taking a pain reliever or fever reducer.
  • You have a higher risk of stomach bleeding.
  • You have stomach problems, including heartburn, GERD (gastroesophageal reflux disorder, or chronic acid reflux), Crohn's disease, or ulcerative colitis.
  • You have high blood pressure (especially if it is not managed well) or a history of heart disease or stroke.
  • You have liver cirrhosis or kidney disease.
  • You have a bleeding disorder.
  • You have unmanaged diabetes.
  • You have asthma.
  • You take a diuretic medication.

If you can't take NSAIDs because you have a stomach or heart condition, or you can't manage the side effects, alternatives include:

  • Topical treatments such as lidocaine. These can reduce stomach irritation and usually don't affect your heart.
  • Acetaminophen, which doesn't reduce inflammation but can help with pain and reduce fever. 
  • Acupuncture
  • Yoga
  • Physical therapy
  • Massage
  • Nonacetylated salicylates, which are anti-inflammatories and can reduce pain but are usually less likely to cause stomach problems. 
  • Capsaicin creams you can get over the counter and by a doctor's prescription. These topical treatments are used to reduce pain.
  • Curcumin, thought to be an anti-inflammatory, is in turmeric. You can also take high-quality curcumin supplements of 500 mg twice a day.
  • An anti-inflammatory diet could help reduce inflammation. Avoid or reduce foods such as red meat, sugar (and foods and drinks high in sugar), white flour (and foods that include processed flour), fried foods, and those made with trans fats. Eat foods with anti-inflammatory properties, such as those containing omega-3 fatty acids (such as salmon and nuts), fruits and vegetables, and gut-healthy foods such as yogurt and fermented products.