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Alternative to NSAIDs: How Can We Reduce Risks?

Updated: Apr 19, 2023

What are NSAIDs?

Nonsteroidal anti-inflammatory drugs, or NSAIDs, are common treatments for many illnesses such as arthritis, aches and pains, and headaches. The most common of these drugs are over-the-counter, non-prescription NSAIDs, such as aspirin and ibuprofen. NSAIDs are used for pain relief, inflammation reduction, as a means to treat fever, and as a way to prevent blood from clotting. NSAIDs, especially their over-the-counter variants have become a utilitarian means of treating a broad range of symptoms and illnesses.


NSAIDs work by preventing an enzyme (a protein called cyclooxygenase, or COX) from doing its job. The enzyme has two variants: COX-1 protects the stomach lining from harsh acids and digestive chemicals, and also helps maintain kidney function; COX-2 is produced when joints are injured or inflamed.

Despite their prevalence in our lives, NSAIDs also create a large number of risks that should be addressed. Before taking any NSAIDs, consult your physician if you are pregnant, have high blood pressure, asthma, or a history of kidney or liver disease, or have had ulcers in the past. People older than 65 years of age must be especially careful when taking NSAIDs. Tell your doctor about other medications you are taking. NSAIDs may intensify or counteract the effects of some medications. NSAIDs are also associated with a rise in glycosylated hemoglobin in type 2 diabetes.

From the first day of use, all NSAIDs increase the risk of gastrointestinal bleeding, heart attack, and stroke. The risk and the severity of side effects increases the longer you take NSAIDs. All NSAIDs increase the risk of both bleeding and cardiovascular disease. Selective COX-2 inhibitors are more likely to cause cardiovascular events, whereas less selective NSAIDs are more likely to cause GI bleeds. The risk of bleeding and of cardiovascular events is considerably higher in older people, especially those who take medications that interfere with NSAIDs. NSAIDs affect the cardiovascular, GI, renal, and respiratory systems.

All NSAIDs double the risk of hospitalisation due to heart failure. NSAID use in patients over 65 years more than doubles the risk of acute kidney injury in the next 30 days. Preventable adverse drug reactions (ADRs) are responsible for 10% of hospital admissions in older people. NSAIDs are responsible for 30% of hospital admissions for ADRs, mainly due to bleeding, heart attack, stroke, and renal (kidney and bladder) damage.

In the UK, The National Institute for Health and Care Excellence defines high-risk patients as: aged over 65; those with interacting medications; patients with diabetes, hypertension, cardiovascular disease, renal or liver impairment; patients with a history of peptic ulcer or GI bleeding; and those taking long term NSAIDs or maximum doses.

Alternative to NSAIDs

Although NSAIDs are a useful tool for dealing with a broad range of health issues, their risks can sometimes outweigh their benefits. In many cases, especially for people with chronic conditions, or those above 65 years old, NSAIDs present great risks especially when taken for extended periods of time.

Due to the concerning side effect profiles of NSAID medications, there is greater interest in natural compounds, such as dietary supplements and herbal remedies, which have been used for centuries to reduce pain and inflammation. Scientists have accelerated their investigations and clinical trials of many of these staple, plant-based anti-inflammatories. From turmeric to boswellia serrata, green tea, hemp, the polyphenol resveratrol and many more.

We are hopeful that humans and animals will benefit from multimodal treatments for health concerns. This approach leads to a reduced reliance on pharmacological agents, with a greater adoption of lifestyle changes such as an anti-inflammatory diet, exercise, weight loss, physical therapy, joint-supporting splints, massage, acupuncture and yoga, just to name a few.


British Journal of General Practice. The dangers of NSAIDs

Pirmohamed M, James S, Meakin S, et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ 2004; 329(7456): 15–19 Bhala N, Emberson J, Merhi A, et al. Vascular and upper gastrointestinal effects of nonsteroidal anti-inflammatory drugs: meta analysis of individual participant data from randomised trials. Lancet 2013; 382(9894): 769–779.

Koffeman AR, Valkhoff VE, Celik S, et al. Highrisk use of over-the-counter non-steroidal anti-inflammatory drugs: a population-based cross-sectional study. Br J Gen Pract 2014; DOI: 10.3399/bjgp14X677815.

S.G. Smith, MB, CCFP Dangers of Non-Steroidal Anti-inflammatory Drugs in the Elderly

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