What are NSAIDs?

Non-steroidal anti-inflammatory drugs, also known as NSAIDs are medicines that are used to relieve pain, and reduce swelling (inflammation).

Examples include aspirin, naproxen, ibuprofen, diclofenac, and COX-2 inhibitors such as celecoxib and meloxicam.

In Australia, you can obtain NSAIDs with a doctor’s prescription, and you can buy lower-dose forms over-the-counter in a pharmacy.

What are NSAIDs used for?

You can use NSAIDs to relieve symptoms associated with a range of conditions, including:

• pain (for example, headache, toothache, period cramps, muscle strains and sprains)
• inflammation
• fever
• arthritis
• some autoimmune conditions

NSAIDs are widely available and you might have them in your home. You can find NSAIDs in tablets, capsules, creams, liquids, injections, sprays and suppositories.

You can check whether a medicine you’re taking is an NSAID, or contains an NSAID, on the healthdirect medicine page or the NPS MedicineWise website.

What are NSAIDs side effects?

Common side effects that you may experience after taking NSAIDs include nausea, heartburn and indigestion. More serious but less common side effects include stomach bleeding or kidney problems. NSAIDs, including those bought over-the-counter, have also been linked to a small increase in the risk of stroke and heart attack.

NSAIDs (including aspirin) can also trigger asthma in some people. If you have asthma and need an NSAID for pain relief, talk to your doctor first.

Is it safe for me to take NSAIDs?

Don’t take NSAIDs if you:

• are allergic or hypersensitive to them
• are pregnant or planning a pregnancy
• have a kidney or liver condition
• have a gastrointestinal (gut) ulcer or bleeding

Don’t give aspirin to children aged under 12 years old unless advised by a doctor. In children, aspirin can cause a very rare condition known as Reye’s Syndrome, which can be life-threatening.

Who is at risk of side effects?

In general, the risk of side effects can be minimised if you take NSAIDs:

• occasionally
• for a limited time period
• at the lowest dose you need to control your pain, within the dose range recommended by your doctor or pharmacist

The risk of side effects increases if you:

• have medical conditions such as gastro-oesophageal reflux disease (GORD), stomach ulcers, stomach bleeding, high blood pressure, heart problems, diabetes or a kidney or liver condition
• are older than 65, especially if you are frail, as NSAIDS may increase your risk of stroke
• are pregnant or planning a pregnancy
• are dehydrated, especially children, adolescents and older people
• are already taking another medicine that contains an NSAID
• drink alcohol
• take more than the recommended dose or take it for more than a few days at a time

Certain medicines also increase your chance of experiencing side effects, including:

• medicines for cardiovascular disease (including medicines for high blood pressure such as beta blockers, ACE inhibitors and angiotensin receptor blockers (ARBs))
• blood thinners such as warfarin or new oral anticoagulants (also known as NOACs, including rivaroxaban, dabigatran and apixaban)
• the osteoporosis treatment alendronate
• the rheumatoid arthritis treatment methotrexate

Even if these don’t apply to you, it’s important that you always follow the dosing instructions carefully. For children, you need to give the dose written on the bottle or packaging, according to your child’s weight.

You can minimise the changes of stomach upset by taking NSAIDs with food.

There are NSAIDs in many over-the-counter medicines, not just in pain medicines, so you need to read medication labels carefully. There are many brand names for the same medicine and many different types of NSAID available, so you need to take care to avoid an accidental overdose. If you’re unsure, ask your doctor or pharmacist.

You may find NSAIDs in:

• medications for colds and flu
• arthritis creams
• teething gels
• complementary and alternative medicines such as:
• willow tree bark extract
• herbal arthritis pills

You need to be careful not to overdose on NSAIDs by accident. For example if you have a cold, don’t take one NSAID for headache and another NSAID at the same time in a medicine for a stuffy nose. If you take an NSAID for a chronic (long-term) condition such as arthritis, ask your doctor or pharmacist before taking cold and flu medicines.

Stop taking NSAIDs and see your doctor if you notice anything wrong, especially any signs of stomach bleeding, such as:

• abdominal pain
• blood in your stool (poo), or very dark stool
• dark coffee-coloured vomit

When should I talk to my doctor?

Talk to your doctor if you have questions about the benefits and risks of NSAIDs. For many people, the health benefits of treatment outweigh the known risks.

If you are buying over-the-counter NSAIDs, talk to your pharmacist or your doctor.

If you buy NSAIDs over-the-counter, follow the instructions closely and do not exceed the recommended dose or duration of treatment.

Do not give NSAIDs to your child for more than 48 hours without seeing a doctor.

The Society of Hospital Pharmacists of Australia recommends that older people avoid regular use of NSAIDS. For more information, visit the Choosing Wisely Australia website. Your pharmacist can help you find a more suitable medicine.