Long-term NSAID use: understanding the risks without fear

Linda Caddick, Registered Pharmacist

For many people living with arthritis, non-steroidal anti-inflammatory drugs (NSAIDs) can be an important part of pain relief. Medicines such as ibuprofen, diclofenac, naproxen and celecoxib can reduce inflammation in joints and help people keep moving, sleeping and doing the things that matter.  

Some NSAIDs are available from a pharmacy at lower strength, including in some cold and flu medicines. Stronger or slow-release options usually need a prescription.

Like all medicines, NSAIDs have benefits and risks. Knowing about these risks does not mean you should stop taking pain relief you need. It means you can use it as safely as possible, with advice from your doctor or pharmacist if you are concerned. Not treating ongoing pain is usually worse for us long term than treating pain with a medicine that is appropriate for you. 

The most common side effects of NSAIDs involve the stomach and gut. Some people may notice heartburn, bloating, stomach pain, nausea, diarrhoea or constipation. More serious problems, such as stomach ulcers or gastrointestinal bleeding, are less common but important. Taking NSAIDs with food, milk or an antacid may reduce stomach symptoms. People with a history of stomach ulcers or gastrointestinal bleeding should check carefully before using NSAIDs. You may need to take an extra medicine at the same time, to protect your gut. 

NSAIDs can affect the kidneys, especially when taken long term or by people who already have reduced kidney function. The risk can be higher for older adults, people who are dehydrated, or those taking medicines such as diuretics or ACE inhibitors (usually taken for high blood pressure). NSAIDs may also cause fluid and salt retention, which can lead to swelling and may worsen high blood pressure. 

For some people, NSAIDs may increase the risk of heart attack or stroke. This risk appears to vary depending on the medicine, dose, length of use and a person’s existing health. People with heart failure, difficult-to-manage high blood pressure, or a history of heart attack or stroke should talk with their doctor before taking NSAIDs, even the ones you can buy without a prescription. 

Aspirin and other NSAIDs can bring on an asthma attack. The reported incidence varies widely affecting between 8% and 20% of adult asthmatics. The incidence is increased in asthmatics who also have chronic rhinitis or a history of nasal polyps. Aspirin or NSAID-induced asthma is most likely in 30- to 40-year-olds. It happens only very rarely in children. (Medsafe NZ) 

NSAIDs can interact with other medicines, including blood pressure medicines, blood thinners, corticosteroids and some antidepressants. If you are unsure, ask your regular pharmacist to check for interactions with medicines or health concerns before you start anything new, including cold medicines. 

The safest approach is usually to use the lowest effective dose for the shortest time that gives you pain relief. If you need NSAIDs often or long term, do not manage this alone. Your doctor may recommend monitoring your kidney function and blood pressure or consider options such as a stomach-protecting medicine to take alongside your NSAID. For some people it is safer to use a topical NSAID, paracetamol, or have another plan for pain relief. 

If NSAIDs help you live better with arthritis, that matters. The goal is not to be frightened of them, but to be informed, supported and regularly reviewed so your pain relief remains as safe and effective as possible.

A regular medication review with your GP or pharmacist is important for anyone taking any long-term medicines. Next month we will talk about long term use of paracetamol. In the meantime, feel free to phone our Arthritis Assist team if you have specific questions about your pain relief or other arthritis questions.