NSAID USE and GI Risk: What You Don’t Know Could Hurt You

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), like ibuprofen, are prescription or over-the-counter medications that can help relieve pain from headaches, arthritis and other conditions. However, many patients are unaware that there are certain risks associated with their use, including potentially serious gastrointestinal (GI) side effects. There are a number of myths out there surrounding NSAID use and the potential risks, including:

Myth: I’m just taking over-the-counter NSAIDs so I’m not at risk for GI-related complications.

Fact: Over-the-counter NSAIDs can still cause patients to experience GI complications, which can include diarrhea, abdominal pain, bloating, heartburn and upset stomachs. For one to two percent of patients, GI complications can be much more severe and include bleeding, ulceration and perforation. Many patients often do not report NSAID use to their physicians, thereby placing themselves at risk. It is important to tell your physician about every medication you are taking, including over-the-counter.

Myth: I only take an NSAID a few times a week so I’m not at risk.

Fact: There are many risk factors associated with GI complications from NSAID-use. It is important to speak with your doctor if you are taking NSAIDs to assess your potential risk for complications.

Myth: GI-side effects related to NSAID use are mild and harmless and can cause no long-term damage.

Fact: Although mild irritation and discomfort can occur, it is estimated that GI hemorrhages due to NSAID use account for approximately 60,000-120,000 hospital admissions annually. Estimated deaths from NSAID-related GI events range from 3,200 to more than 16,000 per year in the United States.

Myth: I would know if my NSAID regimen is causing a serious GI issue.

Fact: Over 80 percent of patients with serious GI complications have no prior symptoms or warning signals. If you are using NSAIDs, it’s important to talk to your doctor about these risks and how you can address them.

Myth: All NSAID users have the same risk for GI-side effects.

Fact: Certain conditions carry an increased risk. Up to 60 percent of arthritis patients have NSAID-associated GI side effects, compared to 1-2 percent of the general population. Patients taking low-dose aspirin for cardiovascular protection in addition to another NSAID have a two- to four-fold increased risk of gastrointestinal bleeding compared with those not taking these medications. Older age is also associated with increased risk of GI bleeding. It is important to speak with your doctor to assess individual risk and determine how to address them.

• A note for heart patients taking clopidogrel (Plavix®): There is some evidence that taking a proton pump inhibitor to reduce the GI risks of clopidogrel may reduce clopidogrel's effectiveness. It is important to speak with your doctor to assess your individual risk and how to address it.

Myth: Only my GI specialist needs to know about my NSAID use.

Fact: It’s important that every healthcare provider treating you, including GI specialists, primary care doctors, rheumatologists, cardiologists and nurses are informed of your NSAID use, even over-the-counter. Many patients often do not report NSAID use to their healthcare providers, thereby placing themselves at risk. Therefore, regardless of whether you are taking NSAIDs over-the-counter or by prescription, it is important to connect with a physician to discuss your risks.

Myth: I’ve been prescribed something to take with an NSAID but I feel ok, so don’t need to take it as often.

Fact: Patients who are prescribed NSAID therapy or GI protective co-therapy by their physician may neglect to take it as prescribed, which may be detrimental to their GI health. As with any medication, prescription or over-the-counter, it’s important to take it as prescribed or recommended on the label.

Myth: There are no options for managing NSAID-related GI issues.

Fact: There are many options available for patients who may be at risk for NSAID-related GI complications. One of the first steps is for physicians to consider whether NSAID therapy is necessary at all and whether patients can be managed with non-NSAID analgesics such as acetaminophen or celecoxib (Celebrex®) which may be safer for certain patients. If NSAID therapy is necessary, physicians may start with the lowest dose.

In patients who require full-dose NSAID treatment, physicians may add a GI protective co-therapy to reduce the risk for upper GI complications. Physicians may prescribe drugs that reduce the production of stomach acid such as H2 antagonists, like famotidine (Pepcid®), rantinidine (Zantac® or Tritec®), a proton pump inhibitor (PPI), such as or omeprazole (Prilosec®), lansoprazole (Prevacid®), esomeprazole (Nexium®), pantoprazole (Protonix® ) or other co-therapies which reduce NSAIDS GI risk such as misoprostol (Cytotec®) or COX-2 Inhibitors, like celecoxib (Celebrex®), which is still considered a safe option for some patients.

Click here for a downloadable factsheet on the risks of NSAIDs.