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Even Over-The-Counter Painkillers Pose Risks: Know Your NSAIDs

Even Over-The-Counter Painkillers Pose Risks: Know Your NSAIDs

Written by PGY1 Pharmacy Resident Victoria Schwalm, PharmD

Headaches, back aches, and all the minor bumps and bruises that come with everyday life—lots of accidents and activities can leave us reaching for the painkillers.

But you should know that even common household painkillers pose their risks and need to be used responsibly.

What Are NSAIDs?

Non-steroidal anti-inflammatory medications, also known as NSAIDs, are commonly used to relieve pain and reduce inflammation. Common examples of NSAIDs include aspirin, ibuprofen (Motrin, Advil), and naproxen (Aleve), which can be bought over-the-counter (OTC). Others are available by prescription only, including some OTC NSAIDs that be prescribed by a doctor in higher strengths.

But although some NSAIDs can be bought OTC, these medications are not necessarily safe for everyone, as they come with potential side effects and drug interactions—and should even be avoided by some.

In general, NSAIDs should only be used as short-term pain relief, as there are risks associated with long-term use.

NSAID Side Effects:

In most cases, NSAIDs cause minimal side effects, however, there is some potential for more serious side effects, especially with higher doses or longer use.

Common side effects include nausea, diarrhea, vomiting, headache, or dizziness.

More severe, less common side effects may include:

  • Stomach upset, ulcers, and bleeding – It is recommended to take NSAIDs with food to lessen the chance of an upset stomach. However, long-term use can still lead to ulcers or bleeding of the stomach or intestines. Therefore, in most people long-term use is not recommended.
  • Kidney damage – NSAIDs can harm the kidneys, even if used only for a short time. The use of NSAIDs in people who have kidney disease is not recommended.
  • Liver damage – Long-term use of NSAIDs can harm the liver, especially at high doses.
  • Ringing in the ears – Also known as tinnitus, it is common in those who take high doses of aspirin.

NSAID Drug-Interactions:

When taking NSAIDs with other medications, you should be careful of harmful drug interactions. The interaction may be dependent on the dose and length of NSAID use. Check with your doctor before taking OTC NSAIDs, if you are taking any of the following medications:

  • Blood thinners – When taking NSAIDs while on blood thinners, there is an increased risk of bleeding, so it is not recommended.
  • Antidepressants – Selective serotonin reuptake inhibitors, or SSRIs, can increase the risk of bleeding when taken with NSAIDs. NSAIDs can also diminish the therapeutic effect of SSRIs.
  • Blood pressure medications – NSAIDs can increase blood pressure and may reduce the effect of blood pressure medications.
  • Aspirin – When NSAIDs and aspirin are taken together, there is an increased risk of bleeding. Additionally, NSAIDs decrease benefits that aspirin can have for your heart.
  • Diuretics – NSAIDs can reduce the effect of diuretics, also called “water pills.” When using NSAIDs and diuretics together, there is an increased risk of kidney injury.
  • Lithium – When taken with NSAIDs, the side effects for lithium can increase due to being eliminated by the kidneys.

Are NSAIDs safe for everyone?

No, people with certain medical conditions should avoid NSAIDs. In order to ensure NSAIDs are safe for you, talk with your doctor or pharmacist prior to NSAID use,An older man talks with his doctor about medication safety. especially if you have any of the following conditions:

  • Kidney disease, heart failure, or liver disease – Avoid NSAIDs as they can worsen these conditions.
  • Heart disease or prior stroke – NSAIDs, except for aspirin, can increase the risk of heart attack and stroke, especially in people who have heart disease.
  • History of stomach ulcers – NSAIDs can cause stomach ulcers with long-term use, so people with history of stomach ulcers may need additional medication to protect the stomach and intestines if taking an NSAID.
  • Having surgery – Consult your doctor as most NSAIDs need to be stopped prior to surgery to lower the risk of bleeding.
  • Pregnancy – Avoid NSAIDs during pregnancy.


  • When taking NSAIDs, it is important to take the lowest dose for shortest amount of time.
  • Take NSAIDs with food to lessen the stomach upset.
  • Avoid the use of alcohol when taking NSAIDs due to the increased risk of bleeding.
  • Consult your doctor or pharmacist to ensure using NSAIDs are safe for you.

More Resources

Click here for more information about NSAIDs from the US Food & Drug Administration.

Click here to learn more about Pain Reliever Safety from Poison Control.