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What are the possible risks and side-effects of NSAIDs?

Standard NSAIDs such as ibuprofen and naproxen work by blocking enzymes called COX 1 and COX 2, which are important in causing inflammation but can also affect the stomach. Newer NSAIDs (often referred to as coxibs) only block COX 2 enzymes and were designed to reduce side-effects, particularly on the digestive system.

If you're at risk of ulceration or bleeding of the digestive system your doctor may recommend:

  • either a coxib such as celecoxib or etoricoxib
  • or a standard NSAID (e.g. ibuprofen or naproxen) along with another drug called a proton-pump inhibitor (PPI) such as omeprazole or lansoprazole to help protect the stomach
  • or, if the risk is thought to be high, a coxib along with a PPI.

There’s evidence that all NSAIDs are linked to a small increase in the risk of having a heart attack or stroke, so they may not be suitable for you if you smoke or if you have or have ever had:

  • heart disease, a heart attack or stroke
  • peripheral vascular disease (circulation problems in the limbs, usually the legs)
  • high blood pressure or cholesterol levels
  • diabetes.

You should also be aware of these potential risks with over-the-counter NSAIDs.

If your kidneys aren’t working as well as they should, your doctor may ask for a test and may reduce the dose of NSAID you’re given or even decide that they’re best avoided.


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