Warnings about side effects of NSAIDs

In this section
NSAIDs you can buy over the counter
NSAIDs your doctor may prescribe
Guidelines for doctors

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to treat pain and inflammation. Ibuprofen is probably the best-known NSAID.

People who take high doses of some NSAIDs for a long time may have a slightly higher risk of getting a heart attack or a stroke. High doses of NSAIDs may be used over a long period of time to treat conditions such as arthritis.

It's not always clear what counts as a long time for taking NSAIDs. In some research, two-thirds of the heart attacks happened in studies where people took NSAIDs for a year or longer.¹

Below, we look at the different kinds of NSAIDs and what the research that has been done so far shows about their safety.

NSAIDs you can buy over the counter

You can buy low doses of an NSAID called ibuprofen at a pharmacy. When taken at this lower dose for a short time, ibuprofen doesn't seem to increase people's risk of having a heart attack or a stroke.²

You can also get larger doses of ibuprofen on prescription from a doctor (see our information on prescription ibuprofen below). Taking these larger doses every day may slightly increase your risk of a heart attack or a stroke. But these doses are higher than the amount you'd take for a headache or other kinds of short-term pain.

NSAIDs your doctor may prescribe

Selective COX-2 inhibitors

Selective COX-2 inhibitors are a newer type of NSAID. Some people got stomach problems as a side effect of taking older NSAIDs. COX-2 inhibitors were designed to cause less irritation to your stomach. But research has found that these newer drugs can slightly increase your risk of a heart attack or a stroke.

COX-2 inhibitors called valdecoxib (brand name Bextra) and rofecoxib (Vioxx) have been taken off the market because of their side effects.²

Other COX-2 inhibitors are still available in the UK. These include:

• celecoxib (Celebrex)
• etoricoxib (Arcoxia).

The overall risk of having a heart attack or a stroke when taking these drugs is fairly small. For every 1,000 people regularly taking high doses, an extra three people will have a heart attack or a stroke.¹ Your doctor can help you weigh up the risks and benefits of these drugs.

Also, you should not take etoricoxib if you have high blood pressure.³ But you can take it once your blood pressure is under control.

Other NSAIDs

There are several NSAIDs that aren't COX-2 inhibitors, which may also be prescribed by your doctor. They include (with brand names):

• diclofenac (Diclomax, Motifene, Voltarol)
• etodolac
• ibuprofen
• ketoprofen (Oruvail, Orudis)
• meloxicam (Mobic)
• naproxen (Naprosyn, Synflex).

Research has found that regularly taking high doses of ibuprofen or diclofenac over a long period of time may increase your risk of getting a heart attack or a stroke.²

We don't know exactly how big the risk is, or how it varies between the different drugs. The research that has been done so far suggests that:

• Taking diclofenac has a similar risk of heart attack to some COX-2 inhibitors.² That would mean three extra heart attacks or strokes for every 1,000 people taking high doses every day
• Naproxen may be safer than COX-2 inhibitors.²

Guidelines for doctors say that for most people, the benefits of these drugs outweigh the risks.⁴ The risks are probably lower for people who only take NSAIDs for a short time or take smaller doses.²

Guidelines for doctors

Doctors have guidelines about how they should prescribe COX-2 inhibitors and other NSAIDs. They say that:²

• People should take the lowest dose of an NSAID that works for them
• People should only take NSAIDs for as long as they need to. People taking them for a long time should have their treatment reviewed regularly
• People who already have heart disease shouldn't take COX-2 inhibitors
• Doctors should weigh up the risks and benefits of NSAIDs for each person. For example, your doctor may suggest a COX-2 inhibitor if you're at risk of stomach problems but you're not at risking of having a heart attack.
• People are more likely to get stomach problems if they take aspirin as well as an NSAID. People should only take aspirin and an NSAID together if they really need to.

If you're worried about the medicine you're taking, talk to your doctor.