Pain & inflammation
NSAIDs
Non-steroidal anti-inflammatory drugs — Common anti-inflammatory painkillers with important gastrointestinal, renal and cardiovascular cautions.
Education and reference only. This is a plain-language class overview — it deliberately contains no doses. Always check the current Summary of Product Characteristics (SmPC), the BNF and your local formulary before prescribing or administering any medicine.
What it is
NSAIDs such as ibuprofen and naproxen relieve pain, inflammation and fever. They are very widely used — including over the counter — but carry real risks that are easy to underestimate, especially in older people and those with other conditions.
How it works
They inhibit cyclo-oxygenase (COX) enzymes, reducing prostaglandins that drive pain and inflammation. The same prostaglandins protect the stomach lining and support kidney blood flow, which explains the characteristic gastrointestinal and renal risks.
In practice
In practice the safest NSAID use is the lowest dose for the shortest time, with a clear look at the person in front of you: age, kidney function, heart failure, ulcer history and other drugs all raise the risk. Co-prescribe gastroprotection where indicated, avoid stacking NSAIDs (including over-the-counter ones), and prefer alternatives in those with significant renal or cardiovascular disease.
Examples
Practical use
How to take it & use it well
- Take it with or just after food or a glass of milk to reduce the chance of stomach irritation.
- Use the lowest amount that controls your pain for the shortest time needed rather than taking it routinely long term.
- Swallow tablets whole with water and do not lie down straight after taking it.
- If you miss a dose, take it when you remember unless it is nearly time for the next one, then skip it. Do not double up.
- Stop and seek advice if you get stomach pain, black stools, vomiting blood, or swelling of the ankles, as these can signal a problem.
- Stay well hydrated and avoid these painkillers during episodes of dehydration or vomiting, which can stress the kidneys.
Common uses
- Musculoskeletal pain and inflammation
- Acute pain and dysmenorrhoea
- Gout and inflammatory arthritis
Monitoring
- Renal function and blood pressure on regular use, especially in those at risk
- Signs of GI bleeding
- Need for continued use
Weighing it up
Advantages & disadvantages
Advantages
- They are effective for pain, especially when inflammation is involved, such as in arthritis, sprains and period pain.
- They also reduce fever and swelling.
- Many are available without a prescription for short-term use.
- They work fairly quickly for everyday aches and pains.
- They come in tablets, gels and other forms, so treatment can be matched to the problem.
Disadvantages
- They can irritate the stomach and cause ulcers or bleeding, especially with prolonged use or in older people.
- They can affect the kidneys, particularly if you are dehydrated or already have kidney problems.
- They can raise blood pressure and are not ideal for people with heart failure.
- They are not suitable for some people, including many with stomach, kidney or heart conditions.
- They can trigger asthma symptoms in a minority of people.
Key safety principles
What to watch for
- Gastrointestinal bleeding and ulceration — risk rises with age, with steroids or anticoagulants, and consider gastroprotection.
- Can worsen kidney function and heart failure, and raise blood pressure.
- Some agents carry a higher cardiovascular risk; use the lowest effective dose for the shortest time.
- Caution in asthma (can trigger symptoms in susceptible people).
Key interactions
What to avoid or check alongside
- Taking them with blood thinners or aspirin increases the risk of serious bleeding.
- Combining them with ACE inhibitors or ARBs and water tablets can harm the kidneys, sometimes called the 'triple whammy'.
- They can reduce the effect of some blood pressure medicines.
- Taking them with steroids increases the risk of stomach ulcers.
- They can raise the levels of some medicines such as lithium and methotrexate.
- Alcohol adds to the risk of stomach irritation and bleeding.
Patient & carer advice
- Take with food and use the lowest dose for the shortest time
- Report indigestion, black stools or vomiting blood
- Avoid combining different NSAIDs, including over-the-counter ones
Use with
Related clinical calculators
Dose and risk decisions for this class often depend on renal function, weight or bleeding/stroke risk. These tools help:
Answers
NSAIDs: frequently asked questions
Can I take it with paracetamol?
Yes, paracetamol and an NSAID can usually be taken together and are sometimes combined for better pain relief. Check with your pharmacist if you are unsure.
Can I take it long term?
It is best used for the shortest time at the lowest effective amount. Long-term use raises the risk of stomach, kidney and heart problems, so should be reviewed by your GP.
Can I drink alcohol with it?
Alcohol adds to the risk of stomach irritation and bleeding, so it is sensible to limit drinking while taking these painkillers.
Is it safe in pregnancy?
NSAIDs are generally avoided in pregnancy, especially later on. Paracetamol is usually preferred. Speak to your pharmacist or midwife for advice.
Who should avoid NSAIDs?
People with stomach ulcers, certain kidney or heart conditions, or some asthma sufferers should be cautious or avoid them. Always check with a pharmacist if you have these conditions.
Authoritative sources
Always verify against the source
This overview is for orientation. For doses, interactions, contra-indications and the full monograph, use:
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