Side effects of painkillers: NSAIDs

Painkillers from the NSAID group (Non-Steroid Anti-Inflammatory Drugs) such as Ibuprofen and Diclofenac are often prescribed for conditions such as inflammation, rheumatism, kidney stones and muscle pain. Some NSAIDs are also prescribed for congenital heart defects or heart attacks (aspirin). Most NSAID painkillers are available over the counter, which carries a certain risk. Knowledge about the possible side effects of these medications is therefore of the utmost importance for users.

Side effects of NSAIDs

  • What side effects do NSAIDs have?
  • What are the most common side effects?
  • Dosage options for NSAIDs
  • How can the side effects be minimized?
  • Proton pump inhibitors when using diclofenac and ibuprofen
  • Long term side effects
  • Conclusion


What side effects do NSAIDs have?

The two main problems common to all NSAIDs are that they inhibit platelets (and therefore blood clotting) and that they stimulate the production of stomach acid. Increased gastric juice production can lead to a stomach ulcer (gastritis), irritation of the stomach and stomach bleeding.In addition to being an analgesic, NSAIDs are also very effective in reducing fever. However, sometimes this fever is caused by viruses that inhibit blood clotting. NSAIDs also inhibit clotting. If used while the patient is suffering from a viral fever, this can lead to life-threatening bleeding. For these reasons, doctors should never prescribe these painkillers when an (undiagnosed) viral condition is suspected.

What are the most common side effects?

Heartburn, abdominal pain, nerves, stomach ulcers and stomach bleeding are the most common side effects of NSAIDs. People who have had a stomach bleeding in the past should only use these medicines under close medical supervision. If you have dark stools or severe abdominal pain, report this to your doctor immediately. These dark-colored stools may indicate bleeding in your stomach.

Dosage options for NSAIDs

These medications can be administered in different ways. They are available as suppositories, tablets and intravenous injections. Suppositories are suitable for patients who cannot take the pills orally. Injections and suppositories have the advantage that the medicines do not have to pass through the stomach. The advantages of this are that the medications are not broken down in the stomach and that the stomach is less affected by the side effects of NSAIDs.

How can the side effects be minimized?

NSAIDs should be taken with a full glass of water. One must also strictly adhere to the prescribed dosage. It is also important that the pills are not first chewed, crushed or crushed before taking them. If this does happen, the active substances will be released too quickly, resulting in the side effects becoming stronger and the healing effect reduced.Side effects of NSAIDs, such as stomach ulcers and stomach irritation, can be partially prevented by drinking milk during intake . The fat from the milk then forms a small protective layer on the stomach wall. Magnesium hydroxide and aluminum hydroxide tablets, which are taken together with painkillers, can also counteract the side effects.Persons with a blood clotting disorder, kidney disease, liver disease or heart problems, or patients who are allergic to NSAIDs should discuss this with their doctor before deciding to use these medications. If you have a history of stomach ulcers or stomach bleeding, you should report this to your doctor.If you are feverish for more than two days, your doctor will do some blood tests before deciding to use NSAIDs.

Proton pump inhibitors when using diclofenac and ibuprofen

Proton pump inhibitors are medications used to moderate the side effects of NSAIDs. Omeprazole is the most commonly used proton inhibitor in the Netherlands. The effect of omeprazole is based on the fact that this medicine inhibits the so-called proton pump in the stomach. This pump is responsible for the secretion of acid in the stomach by the parietal cells. By irreversibly inhibiting this proton pump, the acidity of the stomach is reduced, which reduces the risk of stomach ulcers and damage to the esophagus. Omeprazole is often used together with ibuprofen and diclofenac, among others. These painkillers inhibit the production of prostaglandin and stimulate stomach acid production. Because prostaglandin is also important for the construction of the stomach mucosa, it becomes very thin and vulnerable. Omeprazole therefore protects the gastric mucosa against an overly acidic stomach environment.

Long term side effects

Using NSAIDs for long periods of time can lead to irreversible kidney damage. They can also significantly worsen asthma. Relatively recently, a new type of NSAIDs was developed, which are said to have fewer side effects than existing painkillers. These drugs, known as Vioxx or Celebrex, belong to the group of so-called COX-2 inhibitors. In 2004, a worldwide scandal revealed that the drug Vioxx (rofecoxib) can cause heart problems with long-term use. Vioxx was taken off the market at the time. The question is therefore whether the disadvantages of COX-2 inhibitors outweigh the advantages. NSAIDs are also known to be bad for the development of the unborn fetus. The concentration of NSAIDs in breast milk is too low to be harmful to the child. Breastfeeding in combination with the use of these painkillers is therefore not dangerous, although it is generally avoided.


NSAIDs are commonly used painkillers, but use them with caution. There is a certain risk of stomach ulcers and intestinal bleeding. Excessive and long-term use can also lead to kidney problems and liver failure. Consult your doctor before use and inform him immediately if you experience any unpleasant side effects of this medication.

read more

  • Top 100 most commonly used medicines in the Netherlands
  • Ibuprofen; operation, application and side effects
  • Diclofenac; operation, application and side effects
  • Paracetamol effect, application and side effects
  • Omeprazole; operation, application and side effects

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