Non-steroidal anti-inflammatory drugs (NSAIDS) - Interactions 

Interactions  

You may not always be able to take non-steroidal anti-inflammatory drugs (NSAIDs) in combination with other medicines. This is because some combinations of medicines can cause harmful side effects.

Taking NSAIDs can also make certain medicines less effective. This could be potentially dangerous if these other medicines are treating a serious condition, such as high blood pressure (hypertension).

Some commonly used medications known to interact with NSAIDs are outlined below.

(This is not a complete list; always carefully read the information leaflet that comes with your medication in case there are other interactions that apply to you).

Low-dose aspirin

Low-dose aspirin is given as a preventative treatment to thin the blood in people thought to be at risk of a blood clot which could then trigger a heart attack and stroke.

The use of NSAIDs are not usually recommended for people taking low-dose aspirin because:

  • NSAIDs can make the aspirin less effective in thinning the blood
  • the combination of the two medications can increase the risk of stomach ulcers forming

If the use of an NSAID is thought to be absolutely necessary then you may be switched to an alternative blood thinning medication such as clopidogrel. This will require an H-2 antagonist to also be prescribed as PPIs cannot be used with clopdorel.

Ciclosporin

Ciclosporin is a medication used to treat autoimmune conditions such as arthritis or ulcerative colitis.

It is also used in people who have received an organ transplant to prevent their body rejecting the transplant.

There is a small risk of experiencing kidney and liver damage if you take NSAIDs while also taking ciclosporin.

So if you need to take both medications at the same time you may be referred for regular blood tests so the state of your liver and kidneys can be assessed.

Diuretics

Diuretics are a group of medications that help remove fluid from the body and are often used in the treatment of high blood pressure.

Diuretics are generally safe to take in combination with NSAIDs but you will need to be monitored as they can occasionally cause kidney damage and also lead to a rise in blood pressure.

Lithium

Lithium is a type of medication used to treat bipolar disorder and severe depression.

Taking NSAIDs in combination with lithium can disrupt the body’s ability to remove lithium from the body which can lead to a dangerous build-up of lithium levels.

If using NSAIDs is thought to be absolutely necessary, your dosage of lithium may need to be reduced and you will need regular blood tests to check lithium levels.

You should be alert for the symptoms of lithium poisoning, which include:

  • ataxia (loss of balance and co-ordination)
  • blurred vision
  • dizziness 
  • muscle twitching
  • tinnitus (ringing in your ears)

Methotrexate

Methotrexate is a medication used to treat rheumatoid arthritis. Seek advice from a doctor before taking methotrexate alongside NSAIDs.

Phenytoin

Phenytoin is a medication used to treat epilepsy. Seek advice from a doctor before taking phenytoin alongside NSAIDs.

Selective serotonin reuptake inhibitors

Selective serotonin reuptake inhibitors (SSRIs) are a group of medications used to treat depression as well as a number of other mental health conditions, such as anxiety disorder and obsessive compulsive disorder.

There is evidence that taking SSRIs in combination with an NSAID can increase the risk of a person experiencing bleeding inside their digestive system. It's likely that long-term use will also require a PPI or H-2 antagonist to be prescribed to reduce this risk.

The risk is thought to be small, but as a precaution you should be alert for signs that bleeding has taken place.

Depending on the location and type of blood vessel, you may have long-term bleeding which could lead to anaemia. Symptoms of anaemia include:

Alternatively, the bleeding can be rapid and massive, causing you to vomit blood or pass stools that are black and tar-like.

Warfarin

Warfarin is a medication used to treat people with a history of blood clots, or those thought to have a high risk of developing blood clots at a later date.

The use of NSAIDs is not usually recommended for people taking warfarin as it can enhance the effects of the medication and make you prone to excessive bleeding. In rare cases, a specialist may prescribe this combination.

Alcohol

It is usually safe to drink alcohol while taking an NSAID, as long as you stick to the recommended daily limits (three to four units of alcohol a day for men, and two to three units for women).

Drinking more than the recommended daily limit of alcohol may irritate your stomach lining. Therefore, you may be unable to take NSAIDs if you are going to drink more than the recommended daily limit.

If you are a heavy drinker and you take an NSAID, the risk of you having bleeding in your stomach may be higher. Speak to your GP or pharmacist if you are not sure whether you should be taking NSAIDs.

Food

There are no known interactions between NSAIDs and food. Ideally, take NSAIDs after eating and avoid taking them on an empty stomach. This will help minimise the risk of the medicine upsetting your stomach.

Other NSAIDs

It is always best to use one type of NSAID at a time to minimise the risks of side effects. If you have been prescribed a prescription-only NSAID, such as celecoxib, avoid taking any over-the-counter medication that contains ibuprofen or aspirin.

Many cold and flu remedies contain a combination of different medications, one of which is often an NSAID, such as ibuprofen.

So always carefully read the packet to check for possible interactions. Taking these sorts of remedies after already taking an NSAID could be potentially dangerous.


Page last reviewed: 04/06/2014

Next review due: 04/06/2016

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