NSAID Safety: Getting the Most From Anti-Inflammatory Painkillers

What are NSAIDs?

Non-steroidal anti-inflammatory drugs, usually shortened to NSAIDs, are a widely used family of painkillers that also reduce inflammation and fever. Common examples include ibuprofen, naproxen and diclofenac. They are helpful for many everyday problems, from sprains and period pain to arthritis flare-ups, but they are not suitable for everyone and deserve to be used thoughtfully.

NSAIDs work by blocking enzymes called cyclo-oxygenases (COX), which are involved in producing chemicals that drive pain and inflammation. The same enzymes also help protect the stomach lining and support normal kidney function, which is why NSAIDs can cause side effects in those areas.

The main safety concerns

Most people use NSAIDs occasionally without problems, but the key risks are worth understanding.

Stomach and gut

NSAIDs can irritate the stomach lining and, with longer or heavier use, may lead to indigestion, ulcers or bleeding. Warning signs include persistent stomach pain, black or tarry stools, or vomiting that looks like coffee grounds. These need urgent medical attention.

Kidneys

By affecting blood flow within the kidneys, NSAIDs can reduce kidney function, particularly in people who are dehydrated, older, or already have kidney problems. They can also interact with some blood pressure and heart medicines.

Heart and circulation

Regular or high use of some NSAIDs has been linked to a small increase in the risk of heart and circulation problems. This matters most for people who already have cardiovascular disease or several risk factors.

Who should be cautious

Speak to a doctor or pharmacist before using an NSAID if you:

• Have or have had a stomach ulcer or gut bleeding
• Have kidney, liver or heart disease, or high blood pressure
• Have asthma that is sometimes triggered by painkillers
• Are taking blood thinners, steroids, or certain blood pressure tablets
• Are pregnant, as NSAIDs are usually avoided especially in later pregnancy
• Are older, as several risks increase with age

In these situations paracetamol is often a gentler alternative, though it has its own cautions. Our paracetamol vs ibuprofen guide compares the two.

How to use NSAIDs more safely

A few simple habits make a real difference:

• Take the lowest effective amount for the shortest time needed to control your symptoms.
• Take them with or after food to help protect the stomach.
• Never combine two NSAIDs at once, as this raises the risk of side effects without adding benefit.
• Stay well hydrated, especially in hot weather or during illness, to support your kidneys.
• Check other medicines you take, including cold and flu remedies, which may already contain an NSAID.
• Read the patient information leaflet every time, as formulations and advice can differ.

When to stop and seek help

Stop the NSAID and seek medical advice if you notice stomach pain that does not settle, signs of bleeding, swelling of the ankles, breathlessness, or an allergic reaction such as a rash, wheezing or facial swelling. An allergic reaction with difficulty breathing is a medical emergency.

Long-term use

Some people, such as those with arthritis, may need NSAIDs over longer periods. This should always be supervised by a doctor, who may add a stomach-protecting medicine, monitor kidney function, and review whether the NSAID is still the best option. If you find you are relying on painkillers regularly, that is a good reason to seek a fuller assessment rather than continuing to self-treat.

You can explore suitable options within our pain range or shop all, but a quick word with a pharmacist first is always wise.

The bottom line

NSAIDs are effective and convenient, but their benefits come with genuine cautions for the stomach, kidneys and heart. Using the smallest amount for the shortest time, taking them with food, and checking with a pharmacist if you have other health conditions will help you get the relief you need while keeping the risks low.

General information only — not medical advice. Always read the patient information leaflet and consult a doctor or pharmacist before starting any medication.