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NSAIDs: Benefits and Risks

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At some point in the course of your life, you probably have taken a nonsteroidal anti-inflammatory drug (NSAID). These plentiful and often low-cost drugs can ease a lot of problems safely and effectively. But with all medicines, there are risks and benefits to consider.

Benefits

Relieve Pain: At doses available in over-the-counter (OTC) products -- like aspirin, ibuprofen, and naproxen sodium – NSAIDs provide good, short-term pain relief. They can be used for headache, earache, toothache, joint pain, muscle pain, menstrual cramps, strains, and sprains.

Reduce Fever: NSAIDs, used at OTC doses, are antipyretic – meaning they reduce fever. They lower fever by reducing the levels of prostaglandin E(2) in the brain.

Fight Inflammation: At the higher doses available in prescription NSAIDs, the drug can battle inflammation caused by injury or arthritis.  You will not get the full anti-inflammatory effect until you’ve been on the medicine for a week or two. 

Protect Your Heart: NSAIDs can both protect your heart and be dangerous for your heart, depending on which one you use and how much of it you take. Taking low-dose aspirin every day is known to reduce your risk of heart attack and stroke because it prevents your blood from clotting in the vessels leading to your heart and brain. It is even recommended that you take aspirin during a heart attack while you wait for the ambulance.  On the other hand, use of other NSAIDs can lead to heart disease, so it is important to talk with your doctor about which NSAID you should take, how much, and for how long.

Risks

Allergic Reaction: NSAIDs can cause severe allergic reactions, especially in people with asthma, sinus problems or small growths in the nose. Symptoms might include hives, skin rash, facial swelling and wheezing. If you have a life-threatening allergic reaction (throat swelling and difficulty breathing) call 911 immediately.

Reye’s Syndrome: Children and teens should not take any medicine that contains aspirin, but other NSAIDs are generally okay with your doctor’s approval. Aspirin carries a risk of Reye’s syndrome, a rare but deadly illness that can affect the brain and liver.

Stomach Problems: Most NSAIDs block the action of both cyclooxygenase (COX) 1 and 2. COX-1 helps protect your stomach lining. When taking NSAIDs, you are left vulnerable to stomach pain, gas, heartburn, nausea, vomiting, diarrhea, constipation, ulcers and bleeding. The risk of stomach problems goes up for people who take NSAIDs frequently, especially for people who are older than 65, have a history of stomach ulcers, or take blood thinners or corticosteroids. Stomach risks can be lessened by taking the medicine with food or acid-blocking drugs. COX-2 selective NSAIDs have a lower risk of causing stomach problems.

Heart Attack and Stroke: Every NSAID (except aspirin) may increase your risk of serious blood clots, heart attack, stroke and heart failure. The FDA has included a warning on labels of NSAIDs warning about this possibility. Your risk increases with higher doses and long-term use. People with existing cardiovascular disease are at highest risk.

Having rheumatoid arthritis or diabetes or being obese already increases your odds of developing heart problems, so adding the risks of long-term NSAID use must be considered seriously. Learn more about lessening these risks in NSAIDs: Side Effects and Solutions.

Kidney Problems and Fluid Retention: NSAIDs can decrease your kidney function. If you notice your urine is cloudy, the amount of urine you pass suddenly decreases or you develop ankle swelling, call your doctor. These symptoms indicate your kidneys may not be working properly. These problems may go away once you stop taking NSAIDs.

Bruising: Because NSAIDs prevent blood from clotting, you may bruise more easily and cuts may bleed for longer than you’re used to. Because of their effects on blood clotting, your doctor will tell you to stop taking NSAIDs before any surgery. Always check with your doctor if bruising is a problem for you.

Interaction With Other Medicines: NSAIDs can increase or decrease the actions of other medicines you take.  NSAIDs can be found in several OTC products, including allergy, sleep, cough and cold medicines, so people may take more than recommended doses without realizing it. NSAIDs can interact with alcohol, high blood pressure medicines, blood thinners and antidepressants. Always check with your doctor or pharmacist before adding any drug or dietary supplement to your treatment to look for interactions.

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