There are a number of situations where the use of non-steroidal anti-inflammatory drugs (NSAIDs) is not recommended.

In some cases, they should only be used if you are directly instructed to by your GP or another qualified healthcare professional.

When to avoid NSAIDs

Children under 16 years old

Aspirin should never be given to children under 16 years of age because there is a small risk it could trigger a serious and potentially fatal condition called Reye’s syndrome. This condition can cause liver and brain damage. Paracetamol or ibuprofen are safer alternatives for children under 16.

Pregnant women

The use of NSAIDs during pregnancy is not recommended unless paracetamol does not effectively treat a particular condition. If an NSAID needs to be used, ibuprofen is the safest NSAID to use during pregnancy. If possible, it's best to avoid taking any medication during pregnancy for minor conditions.

However, it should be taken at the lowest possible dose to treat symptoms for the shortest possible time. NSAIDs, including ibuprofen, should never been taken from the 30th week of pregnancy onwards. This is because it can cause a dangerous rise in blood pressure (pulmonary hypertension) inside the lungs of the baby.

Breastfeeding women

The use of NSAIDs during breastfeeding is not recommended unless it is felt that the benefits of treatment outweigh the risks to your baby. If an NSAID is to be used, ibuprofen will be recommended at the lowest possible dose for the shortest possible time needed to treat your symptoms.

Asthma

Some people with asthma find that taking an NSAID can make their asthma symptoms more severe. If this happens to you, it is best to avoid taking NSAIDs in future (unless directly instructed to by your GP or other qualified health professional), and take paracetamol instead.

Allergic reaction

If you experience an allergic reaction after taking an NSAID (including aspirin), such as swelling of your eyes and lips (angioedema) or a severe skin rash, you should avoid taking NSAIDs in the future.

Cautions

Stomach ulcers

NSAIDs can increase your risk of developing stomach ulcers and experiencing internal bleeding, particularly if taken on a long-term basis. Therefore, if you have an increased risk of developing stomach ulcers and internal bleeding, you may wish to use an alternative medication – read more about alternatives to NSAIDs.

Things that increase your risk of developing stomach ulcers and internal bleeding include:

• being 55 years of age or older
• having a history of stomach ulcers or internal bleeding inside your digestive system
• taking another medication known to increase the risk of stomach ulcers and internal bleeding

Medications known to increase the risk of stomach ulcers and internal bleeding include:

• heparin and warfarin, which are used to prevent blood clots
• aspirin, including low-dose aspirin
• corticosteroids, used to treat inflammation and suppress the immune system
• the two antidepressants known as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)

However, there are some health conditions for which long-term use of NSAIDs may be the only effective method of relieving symptoms. For example:

• persistent back pain
• rheumatoid arthritis 
• osteoarthritis 
• certain other forms of arthritis

If you need to take NSAIDs on a long-term basis and have an increased risk of developing stomach ulcers and bleeding, you will probably be given an additional medication known as a proton pump inhibitor (PPI) or an an H-2 antagonist.

PPIs and H-2 antagonists help to prevent stomach ulcers and internal bleeding by reducing the production of stomach acid. See treating stomach ulcers for more information about PPIs and H-2 antagonists.

If you are taking an NSAID, avoid smoking and drinking large amounts of alcohol as these activities can increase your risk of developing stomach bleeding.

Cardiovascular and kidney conditions

In rare cases, NSAIDs can damage the kidneys and cardiovascular system (the heart and blood vessels).

The use of NSAIDs is not usually recommended for people who have an increased risk of developing cardiovascular or kidney conditions. Examples of these include:

• having heart failure
• having advanced chronic kidney disease
• having a previous history of heart disease or heart attack

Liver disease

If you have liver disease then NSAIDs may not be suitable for you.

Some types of liver disease include:

• alcoholic liver disease – where the liver becomes damaged by alcohol misuse, which in severe cases, can result in cirrhosis (scarring of the liver)
• hepatitis – inflammation of the liver which is often the result of a viral infection, but can also be non-viral
• liver failure – where the liver loses most, or all, of its functioning capability