NSAIDs are one of the most commonly used drug classes in the world.  Studies estimate that up to 30% of the US population may use an over the counter NSAID for the treatment of pain.  Despite the enormous publicity surrounding NSAIDs, misconceptions exist regarding the use and potential side effects of these commonly used medications.

All NSAIDs have a BLACK BOX WARNING, “NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal.”

  1. 70 million prescriptions and over 30 billion doses of NSAIDs including over the counter are consumed each year in the United States. (Medscape, March 11, 2015)
  2. The most common side effect with NSAIDs is an upset stomach and heartburn, which can occur in up to a third of all patients taking them.  However, the more dangerous side effect is bleeding ulcers, which can effect up to 100,000 people per year leading to hospitalization.
  3. All NSAIDs have a BLACK BOX WARNING, “NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal.”
  4. Aspirin was the first NSAID and has a unique ability to prevent platelets from forming clots, which is why it can be used to help prevent heart attacks.  The other NSAIDs can block platelet activity as well, but not like aspirin and therefore don’t have the same effect.
  5. All NSAIDS should be avoided prior to having surgery.
  6. The patients most at risk for NSAID related adverse side effects are over the age of 65.
  7. The American Geriatric Society has recommended that people over 65 avoid taking NSAIDs and if they absolutely need to, take them at the lowest dose for the shortest period of time.
  8. The COX-2 inhibitors, like Celebrex, reportedly are less likely to cause bleeding ulcers than the other NSAIDs, but are associated with adverse cardiac events like heart attacks and stroke.
  9. Do not take Ibuprofen before taking aspirin, as it can prevent the beneficial protective effects of aspirin.  You can, however, take ibuprofen an hour or more after taking your aspirin.
  10. NSAIDs can  cause serious kidney problems when taken chronically and should be avoided in people with kidney problems. NSAIDs can also cause significant fluid retention.

There are a variety of alternatives to NSAIDs for managing pain and inflammation, so make sure to discuss the risks and benefits of your pain medication with your healthcare provider.