NSAIDs, short for non-steroidal anti-inflammatory drugs, are among the most commonly used medications in the United States. Available in prescription strength and over-the-counter, NSAIDs reduce inflammation and pain by interfering with your body's production of chemicals called prostaglandins. Some of the most commonly used NSAIDs include aspirin, ibuprofen, naproxen, ketoprofen and celecoxib. Although effective for a variety of conditions, ranging from arthritis to headaches, taking too many NSAIDs may increase your risk of serious medical problems, some of which may be life-threatening.
NSAIDs are a common cause of ulcers, also known as peptic ulcer disease. Your stomach is the most likely site for an NSAID-induced ulcer to develop. Less commonly, the first part of your intestine, called the duodenum, may be affected. Your risk of developing an NSAID-related ulcer depends on how often you take NSAIDs, the dosage, how long you have been taking NSAIDs and whether you have other risk factors for peptic ulcer disease. Heavy alcohol use, smoking, taking a combination of NSAIDs and a past history of ulcers increase your risk of developing an NSAID-induced ulcer. Symptoms you may experience with a peptic ulcer include dull or burning pain in your upper abdomen when your stomach is empty, reduced appetite, frequent belching, bloating, nausea and vomiting.
An ulcer caused by NSAID use may erode into a blood vessel in your stomach or intestine, leading to gastrointestinal bleeding. Symptoms and signs to look for include sharp, persistent stomach pain, vomiting blood and black stools. With prolonged or severe bleeding, you may develop weakness, paleness and loss of energy. Importantly, gastrointestinal bleeding may not cause obvious signs or symptoms. Take NSAIDs in the lowest, effective dose possible and limit the length of time you take them to reduce your risk of gastrointestinal bleeding. Talk with your doctor if you take NSAIDs for a chronic condition, such as arthritis, to determine the safest option for you.
Heart Attack and Stroke
NSAIDs may increase your risk of having a heart attack or stroke, especially if you have preexisting heart disease. These drugs may increase your blood pressure and contribute to the progression of atherosclerosis, a condition in which your arteries become clogged and blood flow to your heart and brain are reduced. In a January 2011 article published in the medical journal "BMJ," Drs. Sven Trelle and colleagues report that all NSAIDs increase the risk of heart attack and stroke, including ibuprofen. The U.S. Food and Drug Administration requires that all prescription NSAIDs carry a warning about the potential for increased risk of heart attack, stroke and gastrointestinal bleeding associated with use of these drugs.
Taking too many NSAIDs can cause sudden kidney failure or chronic kidney disease. With acute kidney failure, discontinuation of the offending NSAID usually leads to recovery of kidney function. A more subtle form of chronic kidney disease called chronic interstitial nephritis can develop if you take NSAIDs regularly for many years. This condition most often occurs in people taking high doses of NSAIDs for chronic pain. NSAIDs are particularly dangerous if you have preexisting kidney disease.
- American Academy of Orthopaedic Surgeons: What are NSAIDs?
- National Institute of Diabetes and Digestive and Kidney Diseases: NSAIDs and Peptic Ulcers
- American College of Gastroenterology: The Dangers of Aspirin and NSAIDs
- U.S. Food and Drug Administration: Medication Guide for Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
- "BMJ"; Cardiovascular Safety of Non-Steroidal Anti-Inflammatory Drugs: Network Meta-Analysis; Sven Trelle, M.D., et al.; January 2011
- National Kidney Foundation: Pain Medicines (Analgesics)