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Writer's pictureJohn Hayes Jr, MD

Over-the-counter (OTC) nonsteroidal anti-inflammatory drug (NSAIDs) Cautions

Updated: Nov 1, 2023

Over-the-counter (OTC) nonsteroidal anti-inflammatory drug (NSAIDs) Cautions
Over-the-counter (OTC) nonsteroidal anti-inflammatory drug (NSAIDs) Cautions

Too often with self medication they are mixed with other drugs and used for far longer periods than generally advised. Short term usage, when properly prescribed and utilized can be a game changer for many. Also those with certain forms of arthritis require much longer use than other patients hence far more supervision by periodic physician visits and laboratory tests.


Here's an overview of some of the less known by patient side effects most especially found with improper or extended usage.

NSAIDs can irritate the stomach lining and increase the risk of ulcers and gastrointestinal bleeding chemistry. Long-term use or high doses may lead to more serious problems such as perforation of the stomach or intestines.

Some NSAIDs are associated with an increased risk of cardiovascular events, including heart attack and stroke. Risk is often higher in people with pre-existing cardiovascular disease.

NSAIDs may affect kidney function, especially in people with pre-existing kidney disease. Dehydration can exacerbate the risk of kidney problems.

Some people may be allergic to NSAIDs and can experience allergic reactions, ranging from mild rashes to severe anaphylactic shock which can be life threatening.

NSAIDs can interact with other medications, potentially reducing their effectiveness or worse yet cause serious adverse effects. This includes interactions with blood thinners (AKA anticoagulants) certain blood pressure medications, and others. Older adults have a higher risk of complications, such as gastrointestinal bleeding.

Pregnant women should be cautious when using NSAIDs, especially in the third trimester of pregnancy because they can affect the fetal development.

Aspirin, an NSAID, should not be given to children or adolescents with viral infections because of the risk of Reye syndrome, a rare but serious disease that affects the liver and brain.

Long-term use of NSAIDs, even at recommended doses, can lead to tolerance and dependence. Overuse can also mask underlying medical problems, as pain and inflammation are symptoms that indicate a problem.

Adhering to the recommended dosage and duration of use is important and people with pre-existing health conditions or those taking other medications should consult a physician.


Always read and follow the instructions and warnings that come with your medicine. If there are signs of an adverse reaction, such as severe abdominal pain, chest pain, difficulty breathing or swelling, seek immediate medical attention. There are some natural alternatives to NSAIDS, which may be more effective than others. These include but are not limited to fish oils and Omega 3 fatty acids, ginger, curcumin, turmeric, magnesium to name just a few.


As we discussed many times before, for so many conditions not the least of which is chronic pain the mainstay should be anti-inflammatory plant based diet. Blood tests measuring inflammatory markers are also helpful in determining potential causes of pain. You are also aware that we are huge fans of drug free pain management wherever possible. Far more tools now available than even many physicians realize. For example our chronic pain patients who utilize laser and ivory therapy as well as targeted neuro stem oftentimes are able to dramatically reduce the use of pain medication including NSAIDs. The best way to avoid potential interactions and serious drug side effects is to always consult with your physician. ~ We Are Here for You


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