Who Should Not Take NSAIDs? 9 People Who Should Avoid These Pain Relievers

Written by Christina Aungst, PharmD | Reviewed by Austin Ulrich, PharmD, BCACP

Published on August 15, 2024print_outlinedemail_outlined

Key takeaways:

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a common choice for treating pain, fever, or inflammation (swelling). They have several potentially serious side effects. This can make them risky for certain groups of people.
There are people who should not take NSAIDs. These include people with kidney problems, heart conditions, or stomach ulcers or bleeding. Pregnant women, older adults, and those taking blood thinners should also avoid NSAIDs.
These groups of people have a greater risk for serious NSAID side effects, such as kidney damage, heart attacks, and stomach bleeding. Ask a healthcare professional whether NSAIDs are safe for you before taking them.

Kidney disease

Heart disease

Pregnancy

Stomach ulcers

Older adults

Diabetes

Inflammatory bowel disease

Blood thinners

Other interacting meds

FAQs

Bottom line

References

A healthcare professional holds up their hand in a stop gesture. KTStock/iStock via Getty Images Plus

Nonsteroidal anti-inflammatory drugs (NSAIDs) are a very well-known class of medications. Some, such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naproxen), are available over the counter (OTC). Others, such as meloxicam (Mobic) and celecoxib (Celebrex), require a prescription to purchase.

NSAIDs are often a go-to option for treating fevers and minor aches and pains. They also play a crucial role in managing many inflammatory conditions, such as arthritis. But NSAIDs aren’t without risks. Serious side effects, such as a higher risk for bleeding or heart attacks, can make them unsafe for some people.

There are many people who should not take NSAIDs due to a higher risk of severe complications. So how do you know if NSAIDs are safe for you? Below, we detail nine groups of people who may need to avoid NSAIDs.

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1. People with kidney problems

The kidneys are the main organs that help remove NSAIDs from the body. But NSAIDs temporarily reduce blood flow to the kidneys. This isn’t a problem for many people. But if your kidneys aren’t working as expected, this reduced blood flow can damage them. In some cases, this can cause acute (sudden) kidney injury.

It’s often recommended for people with kidney disease or other kidney problems to avoid NSAIDs. But depending on your kidney function, you may be able to safely take lower doses of NSAIDs. A healthcare professional can help you determine which option is safer for you.

2. People with heart or cardiovascular problems

Most NSAIDs carry the risk of heart attacks. This is especially true for people taking high dosages or those who take them regularly for long periods of time.

Can you take NSAIDs if you have hypertension?

If you have hypertension (high blood pressure), you should double-check with a healthcare professional before taking an NSAID. Many of these medications can raise blood pressure. They also interact with some of the most common blood pressure medications. Depending on your personal health risks and current medications, you may need to avoid NSAIDs if you have hypertension.

3. During pregnancy

If you’re pregnant, you likely know there are many medications you should avoid. NSAIDs are on this list. Taking NSAIDs after week 20 of pregnancy can raise the risk of harming a fetus. These medications may affect your baby’s kidney, heart, or lung development. Research isn’t clear whether NSAIDs are safe before the 20th week of pregnancy.

To err on the side of caution, many prenatal care professionals recommend avoiding NSAIDs during all stages of pregnancy.

4. People with a history of stomach ulcers or bleeding

Most NSAIDs are irritating to the stomach lining. This is why digestive side effects, such as heartburn and nausea, are common. But in serious cases, NSAIDs can cause ulcers or bleeding of the stomach and intestines. So if you currently have these gastrointestinal (GI) problems or you’re at risk for developing them, you shouldn’t take NSAIDs. Taking them can make these problems worse. It can also raise the risk of developing stomach or intestinal ulcers or bleeding.

5. Adults ages 65 or older

People ages 65 and older have a greater risk for serious side effects from many medications. NSAIDs are included in this list. Older adults have a greater risk of GI bleeding, kidney damage, and heart problems when taking NSAIDs.

You may not need to completely avoid NSAIDs if you’re 65 or older. Experts generally recommend taking smaller doses and only taking them for short periods of time. You shouldn’t take NSAIDs regularly unless other treatment options aren’t appropriate for your symptoms. Check with a healthcare professional if you’re unsure whether NSAIDs are safe for you.

6. People with Type 2 diabetes

People living with Type 2 diabetes should not take NSAIDs unless absolutely needed. For people with diabetes, NSAIDs may raise the risk of developing heart failure and being hospitalized for it.

The risk of developing heart failure is higher in adults 65 or older and those with higher hemoglobin A1C levels (your average blood sugar over the past 2 to 3 months). The risk is also greater when someone first starts a regular NSAID regimen.

Keep in mind: Many people living with Type 2 diabetes also have kidney disease or heart problems. If you also have these conditions, there are other risks to consider when it comes to taking NSAIDs, as discussed above.

7. People with ulcerative colitis or Crohn’s disease

Ulcerative colitis and Crohn’s disease are two types of inflammatory bowel disease. NSAIDs can worsen ulcerative colitis flare-ups. And they can make Crohn’s disease flare-ups more likely to happen. What’s more, NSAIDs interact with corticosteroids (steroids) like prednisone, a common treatment for these conditions. So it’s recommended to avoid NSAIDs if you have ulcerative colitis or Crohn’s disease.

8. People taking blood thinners

NSAIDs raise your risk of bleeding. This isn’t an issue for most people. But if you take blood thinners, your risk of serious bleeding increases significantly if you also take NSAIDs. This interaction applies to both anticoagulants, such as warfarin (Coumadin, Jantoven) and apixaban (Eliquis), and antiplatelets, such as clopidogrel (Plavix). You shouldn’t take NSAIDs if you take any blood thinners.

One exception to this is aspirin. As mentioned above, aspirin can help prevent unwanted blood clots. It’s sometimes recommended to take aspirin along with certain blood thinners after having a stroke. But you shouldn’t take aspirin with your blood thinner unless your prescriber has told you to do so.

9. People taking other interacting medications, such as diuretics, lithium, or methotrexate

NSAIDs interact with a number of other medications. Some of these combinations can have serious consequences. So it’s good to know whether it’s safe to mix NSAIDs with your other medications.

Notable medications you shouldn’t take with NSAIDs include:

Diuretics (“water pills”): Diuretics, such as furosemide (Lasix) and hydrochlorothiazide (Microzide), work mainly in the kidneys to remove extra fluid from the body. This helps treat hypertension, heart failure, and other conditions. Combining diuretics with NSAIDs raises your risk of kidney damage.
Lithium (Lithobid): Lithium is a mood stabilizer prescribed to help manage symptoms of bipolar disorder. NSAIDs can lower the amount of lithium that’s cleared out of your body. This can lead to lithium toxicity, which can be life threatening in the most severe cases.
Methotrexate (Trexall): Methotrexate is a medication that can help treat cancer and several autoimmune disorders. The kidneys help remove methotrexate from the body. Taking NSAIDs with methotrexate can raise your risk of kidney damage. But there are times when the anti-inflammatory benefits of the combination may outweigh the risks.
Many blood pressure medications: Angiotensin-converting enzyme (ACE) inhibitors — such as lisinopril (Zestril) — and angiotensin II receptor blockers (ARBs) — such as losartan (Cozaar)— are two common blood pressure medications. They work mainly in the kidneys. Combining ACE inhibitors or ARBs with NSAIDs can raise your risk of kidney damage.
Some antidepressants: Selective serotonin reuptake inhibitors (SSRIs) — such as fluoxetine (Prozac) — and serotonin and norepinephrine reuptake inhibitors (SNRIs) — such as duloxetine (Cymbalta) — are common antidepressants. They slightly increase your bleeding risk. But when combined with NSAIDs, you’re more likely to experience serious bleeding. It’s recommended to avoid regular NSAID use if you take an SSRI or SNRI.

This isn’t a comprehensive list of all NSAID interactions. You should share a list of your medications with your prescriber and pharmacist. This can help your healthcare team prevent serious interactions.

Frequently asked questions

What are the side effects of NSAIDs?

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Common

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