NSAIDs: What They Are and How to Use Them Safely

NSAIDs are a group of medicines that reduce pain, fever, and inflammation.

Common ones you probably know are ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin.

Some NSAIDs are over-the-counter; others need a prescription.

They work by blocking enzymes called COX‑1 and COX‑2, which lowers production of prostaglandins—chemicals that cause pain and swelling.

When people use NSAIDs

Most people reach for an NSAID for headaches, muscle aches, arthritis flares, menstrual cramps, or fever.

Short courses at the lowest effective dose usually work well.

For chronic conditions like osteoarthritis, doctors may suggest a regular schedule or alternative treatments rather than long-term high-dose NSAIDs.

Common side effects to watch for

NSAIDs can upset your stomach, cause heartburn, or lead to ulcers and bleeding in the gut.

They can also affect kidney function and, with some drugs or high doses, raise cardiovascular risk.

Older adults, people with prior ulcers, heart disease, kidney problems, or those taking blood thinners face higher risks.

If you notice black or tarry stools, severe belly pain, swelling, or shortness of breath, stop the drug and seek medical help.

Interactions that matter

NSAIDs interact with several medications.

They can increase bleeding risk with anticoagulants (warfarin, direct oral anticoagulants) and reduce the effectiveness of some blood pressure drugs like ACE inhibitors and diuretics.

Combining NSAIDs with other NSAIDs or certain supplements that thin blood (fish oil, vitamin E) adds risk.

Always check with a pharmacist or doctor before mixing drugs.

Topical versus oral NSAIDs

Topical gels and creams with NSAIDs offer pain relief for joints and soft tissues with less systemic exposure.

They can be a good choice for localized osteoarthritis or muscle strains when you want to limit stomach or heart effects.

Still avoid applying them to broken skin.

Pregnancy and NSAIDs

Avoid most NSAIDs in pregnancy, especially after 20 weeks, unless a doctor advises otherwise.

Aspirin in low doses is sometimes prescribed for specific conditions under medical supervision, but don't self-medicate.

Two practical tips to use NSAIDs smarter

- Use the lowest effective dose for the shortest time. If pain improves in a few days, stop.

- Take oral NSAIDs with food or milk to reduce stomach upset. If you need long-term treatment, ask about stomach-protecting options like PPIs.

When to see your doctor

If pain persists despite NSAIDs, if you need them daily, or if you have warning signs like bleeding, swelling, or breathing trouble, contact your healthcare provider.

They can suggest safer strategies, alternative drugs, or tests to find the cause.

Quick recap: NSAIDs are effective for many common pains but carry real risks.

Use them deliberately—know your dose, check interactions, and get medical advice for long-term use.

Alternatives include acetaminophen for mild pain, physical therapy, topical NSAIDs, heat/ice, and exercise programs.

For chronic pain, ask about nonsteroidal options like COX-2 selective drugs or non-drug strategies.

Your pharmacist or doctor can tailor a safer plan based on your health and other meds.

Keep a list of your medicines handy.