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Non-steroidal anti-inflammatories (NSAIDs)

Non-steroidal anti-inflammatories drugs (NSAIDs)

Key points about Non-steroidal anti-inflammatories (NSAIDs)

NSAIDs are a type of pain relief medication that are used for pain caused by inflammation.
Signs of inflammation include redness, warmth, swelling, and pain.
Find out how to take NSAIDs safely and possible side effects.

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Non-steroidal anti-inflammatory drugs (NSAIDs) are mainly used to treat pain and inflammation caused by injury, or by conditions such as gout, rheumatoid arthritis, osteoarthritis, headache, dental pain and period pain. NSAIDs have several side effects and may not be suitable for people who are pregnant or people with stomach problems, asthma, heart, liver or kidney problems. Before taking NSAIDs, check with your healthcare provider if they are suitable for you. Read more about when you should NOT take NSAIDs.

Examples of NSAIDs available in New Zealand
ibuprofen (Ibugesic®, I-Profen®, Nurofen®, Brufen®, Advil®) diclofenac (Voltaren®) naproxen (Noflam®, Naprosyn®) ketoprofen (Oruvail SR®)	celecoxib (Celebrex®) mefenamic acid (Ponstan®) tenoxicam (Tilcotil®)

Many NSAIDs can be bought from your pharmacy without a prescription and some, such as ibuprofen, can be bought from the supermarket. NSAIDs are also available on prescription.

NSAIDs are usually available as tablets or capsules, some are available as a syrup and some are available as gels or creams that can be massaged into the painful area.
Aspirin is also an NSAID, but it is mainly prescribed in low doses to help to keep the blood from clotting, eg, for people who have had a heart attack in the past. Low dose aspirin is also called Aspec® or Cartia®.

Take them with food or immediately after food, to prevent stomach upset.
Use the lowest dose for the shortest time to provide pain relief.
Don't take more than the recommended dose and don't use over-the-counter NSAIDs for longer than 2 to 3 days without checking if it is safe with your healthcare provider.
Don't take more than 1 type of NSAID at a time. Some other medicines also contain NSAIDs, including some cold and flu preparations, so always read the label or ask your pharmacist.
Tell your healthcare provider about all the medicines you are taking before you buy any type of pain relief.
Before taking NSAIDs, check with your healthcare provider that they're right for you.

Depending on the NSAID and the condition being treated, some may work within an hour or two, but with others it could take more time before you feel the full benefit. NSAIDs that are used short-term may need to be taken every 4 to 6 hours because of their short action time. For osteoarthritis and rheumatoid arthritis needing long-term treatment, long-acting NSAIDs that only need to be taken once or twice a day may be used.

NSAIDs are safe for most people but extra care is needed in some situations. Examples include if:

you have high blood pressure
you have heart or kidney problems or asthma
you're aged 65 years or older
you smoke.

The main risks of NSAIDs are how they affect your stomach, heart and kidneys. Read more about the risks of NSAIDs.

When you should NOT take NSAIDs
NSAIDs should NOT be used in some situations as they can be harmful. For example, if you: have current or previous stomach problems such as ulcers or bleeding are pregnant have heart failure or chest pain (angina) have had a stroke or heart attack have chronic kidney disease have had an allergic reaction (such as hives or trouble breathing) to ibuprofen, aspirin, or other similar medications (discuss with your healthcare provider) are taking medicines to reduce blood clots (anticoagulants) such as warfarin, dabigatran and rivaroxaban are also taking other anti-inflammatory medicines, eg, diclofenac (Voltaren®), naproxen (Naprosyn®) or celecoxib (Celebrex) are taking some blood pressure medicines such as ACE inhibitors, ARBs, diuretics. Always check with your healthcare provider before taking NSAIDs. Read more about the risks associated with NSAIDs.

When you should NOT take NSAIDs

NSAIDs should NOT be used in some situations as they can be harmful.

For example, if you:

have current or previous stomach problems such as ulcers or bleeding
are pregnant
have heart failure or chest pain (angina)
have had a stroke or heart attack
have chronic kidney disease
have had an allergic reaction (such as hives or trouble breathing) to ibuprofen, aspirin, or other similar medications (discuss with your healthcare provider)
are taking medicines to reduce blood clots (anticoagulants) such as warfarin, dabigatran and rivaroxaban
are also taking other anti-inflammatory medicines, eg, diclofenac (Voltaren®), naproxen (Naprosyn®) or celecoxib (Celebrex)
are taking some blood pressure medicines such as ACE inhibitors, ARBs, diuretics. Always check with your healthcare provider before taking NSAIDs.

Read more about the risks associated with NSAIDs.

Side effects	What should I do?
Heartburn Indigestion Stomach discomfort Runny poo (diarrhoea)	These are common. Take NSAIDs with food. Talk to your doctor if it they bother you.
Serious stomach problems such as really bad stomach pain, blood in the stool, black or dark colour in your stool, coughing or vomiting up blood, or dark coloured vomit Unusually heavy periods if you are menstruating	Stop taking NSAIDs. Tell your doctor immediately or ring Healthline on 0800 611 116.
Signs of allergic reaction such as skin rashes, itching, swelling of the face, lips, mouth or have problems breathing, like a tight chest or shortness of breath	Stop taking NSAIDs. Tell your doctor immediately or ring Healthline on 0800 611 116.
Swollen ankles, blood in your pee or not peeing at all – these can be signs of a kidney problem.	Stop taking NSAIDs. Tell your doctor immediately or ring Healthline on 0800 611 116.
Chest pain Shortness of breath or trouble breathing Weakness in one part or side of the body Slurred speech	Stop taking NSAIDs. Tell your doctor immediately or ring Healthline on 0800 611 116.
Read more about medicines and side effects and reporting a reaction you think might be a side effect.

Pain topics
Pain relief medications
Ibuprofen for adults
Diclofenac
Naproxen
Aspirin – low dose
Ponstan

The following links provide more information about NSAIDs. Be aware that websites from other countries may have information that differs from New Zealand recommendations.
Non-steroidal anti-inflammatory drugs (NSAIDs)(external link) Rheuminfo
Anti-inflammatory Painkillers(external link) Patient info, UK
The triple whammy(external link) SafeRx, Waitematā DHB, NZ