Non-steroidal anti-inflammatory drugs (NSAIDs) are medicines used to:
- relieve pain
- reduce inflammation (swelling)
- bring down a high temperature
NSAIDs are commonly used, but they're not suitable for everyone. Check with your GP or pharmacist before taking an NSAID.
NSAIDs come as tablets, capsules, creams, gels, injections, plasters and suppositories (capsules inserted into your bottom).
You can get some NSAIDs from your pharmacy without a prescription. These include diclofenac gel and ibuprofen. But you need a prescription for others.
Types of NSAIDs
The main types of NSAIDs used in Ireland include:
- ibuprofen (Nurofen)
- naproxen (Naprosyn)
- diclofenac (Diclac, Difene, Voltarol)
- etofenamate (Etoflam)
- celecoxib (Celebrex)
- mefenamic acid (Mefac or Ponstan)
- etoricoxib (Arcoxia)
- aspirin for pain relief (Disprin)
NSAIDs may be sold or prescribed under these names or the brand name. Brand names also include Advil, Brufen, Brupro, Buplex, Easofen, Ibugel, Fenopine, Melfen and Phorpain. They're all similarly effective, but you may find one works better for you than others.
NSAIDs also comes in a mixed tablet with other medicines such as decongestants to treat colds and flu or other painkillers, for example esomeprazole.
Ibuprofen is available as a mixed tablet with a painkiller called codeine (Nurofen Plus). There are some special warnings for the use of this mixed tablet.
Uses of NSAIDs
NSAIDs are often used to relieve symptoms of:
- headaches
- painful periods
- sprains and strains
- colds and flu
- conditions such as arthritis that can cause long-term pain
They can ease your pain by changing how your body responds to pain.
Check if you can take NSAIDs
Ask a pharmacist or doctor for advice before taking an NSAID if you:
- are age 65 or older
- had an allergic reaction to NSAIDs or any medicine in the past
- take other medicines
- have high blood pressure, diabetes or high cholesterol
- have asthma
- have liver, kidney or heart problems
- have had stomach ulcers or bowel problems
- are pregnant, trying to get pregnant, or breastfeeding
Chickenpox warning
Do not give ibuprofen to an adult or child with chickenpox. It can cause a serious skin reaction.
Pregnant and breastfeeding
Talk to your GP or pharmacist before taking an NSAID if you are:
- pregnant
- trying to get pregnant
- breastfeeding
NSAIDs are not normally recommended in pregnancy unless prescribed by a GP or doctor.
Children and NSAIDs
Some NSAIDs are available without a prescription for children. Others are only available on prescription.
NSAIDs are not suitable for some children. Check with your pharmacist or GP before giving NSAIDs to your child.
Some NSAIDs, such as ibuprofen, can be given to children age 3 months and older as a liquid syrup. Children age 7 and older can usually take it as a tablet or capsule.
Give your child NSAIDs with food or milk so they do not get an upset tummy.
Follow the instructions on the package leaflet.
When you start taking NSAIDs
NSAID tablets or capsules usually start to work within 1 hour.
If you're using a gel or cream it may take 1 to 2 days. For arthritis, you may need to use a gel or cream for up to 7 days to feel the full effect.
When you stop taking NSAIDs, the effects wear off in about 15 hours.
If NSAIDs do not work
If NSAIDs do not work, talk to a pharmacist or GP about trying another painkiller such as paracetamol.
If alternatives do not work, your GP may prescribe a stronger painkiller. Or they may recommend other types of treatment. For example, physiotherapy may help some people with muscle or joint pain.
How and when to take NSAIDs
Always follow the instructions on the medicines label for your NSAID dose. It's best to take the lowest dose that works for the shortest possible time.
If you still need an NSAID after taking it for 10 days, check with your GP before continuing.
Some medicines that are mixed with NSAIDs can only be taken for up to 3 days.
Liquid (oral suspension)
Shake the bottle well and measure out the right amount using a plastic oral syringe or spoon. These come in the medicine packet.
If you do not have an oral syringe or spoon, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not measure the right amount.
Tablets and capsules
Always take NSAID tablets or capsules with a meal, snack or with a drink of milk or water. This helps prevent an upset stomach.
Swallow tablets or capsules whole. Do not chew or crush them.
Gels and creams
Put the gel or creams on the painful area and slowly rub it in. It may feel cool on your skin. Wash your hands afterwards.
Take prescription NSAIDs as your GP or pharmacist tells you.
Plasters and patches
Follow the instructions on the package leaflet. Treat only 1 painful area at a time. Do not use more than 2 NSAID plasters in a 24-hour period.
Moisten the plaster or patch with water before taking it off. This makes it easier to remove.
Suppositories
Suppositories are medicines you push into your bottom (anus).
To use suppositories:
- Go to the toilet beforehand if you need to.
- Wash your hands before and after using the medicine. Also clean around your bottom (anus) with mild soap and water, rinse and pat dry.
- Unwrap the suppository.
- Gently push the suppository into your bottom (anus) with the pointed end first. It needs to go in about 3cm (1 inch).
- Sit or lie still for about 15 minutes. The suppository will melt inside your bottom (anus). This is normal.
If you forget to take it
Take your missed dose of NSAID as soon as you remember, unless it's nearly time for the next dose. In this case, skip the missed dose. Take your next one as normal.
Do not take a double dose if you forgot to take your medicine.
If you often forget to take your medicine, it may help to set a reminder alarm.
Combination tablets with codeine (Nurofen Plus)
Combination or mixed tablets of NSAIDs with codeine (such as Nurofen Plus) are available without prescription. They should not be taken for more than 3 days. Talk to your GP if the pain does not improve after 3 days.
Medicines that have codeine in them can cause addiction or dependence if you take them continuously for more than 3 days.
Keep to the maximum daily dose detailed on the medicine package and leaflet.
Symptoms of addiction to codeine in combination tablets include:
- you find it hard to stop taking it
- you feel you need to take it more often than necessary
If you stop taking codeine suddenly, you may get withdrawal symptoms.
These can include:
- feeling agitated or anxious
- panic attacks
- feeling your heart beat (palpitations)
- difficulty sleeping
- shaking
- sweating
- body aches
- feeling restless
Urgent advice: Contact your GP urgently if
you are taking NSAID and codeine combination tablets and:
- are worried about addiction
- need help with addiction
- want to stop taking codeine
If you take too much
It can be dangerous to take too much of an NSAID.
Emergency action required: Call 112 or 999 or go to an emergency department (ED) if you:
- have fits or seizures
- have difficulty breathing
- are losing consciousness
Do not drive to an ED. Get someone else to drive you or call for an ambulance.
Bring the packet or leaflet and any remaining medicine with you.
NSAIDs with food and alcohol
Generally you do not have to avoid specific foods while taking NSAIDs.
It's usually safe to drink alcohol while taking NSAIDs. But alcohol can irritate your stomach when you are taking an NSAID. Keep to the recommended amount of alcohol per week.
Side effects
Talk to your GP or pharmacist if side effects bother you or do not go away.
Common side effects
There are things you can do to manage common side effects:
Headache
Make sure you rest and drink plenty. Do not drink too much alcohol.
Talk to your GP if the headaches last longer than a week or are severe.
Feeling dizzy
If your medicine makes you feel dizzy when you stand up, try getting up very slowly or stay sitting down until you feel better. If you begin to feel dizzy, lie down so that you do not faint, then sit until you feel better.
Do not stand up too quickly after you've been sitting or lying down. Do not drive, cycle or use tools or machines if you feel dizzy.
If the dizziness does not get better within 1 to 2 days, speak to your pharmacist or GP.
Wind
Try not to eat foods that cause wind (like lentils, beans and onions). Eat smaller meals, eat and drink slowly, and exercise regularly. Speak to your pharmacist about medicines available without prescription that can also help.
Feeling sick (nausea)
Always take NSAID tablets, capsules or liquid with a meal or snack or with a drink of milk. Stick to plain food and do not eat rich or spicy food.
Getting sick (vomiting)
If you are getting sick, try small, frequent sips of water to avoid dehydration. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee.
If you take the combined contraceptive pill or the progestogen-only pill and you're getting sick, your contraception may not protect you from pregnancy. Check the pill packet for advice.
Feeling tired or sleepy
Stop what you're doing and sit or lie down until you feel better. Do not drive, cycle or use tools or machines if you feel tired or sleepy.
Do not drink alcohol as it will make you feel worse.
Change in vision
If your NSAID causes you to have blurred vision, do not drive, cycle or use tools or machinery until this side effect has worn off. Talk to your GP if blurred vision lasts for more than 2 days or is severe.
Diarrhoea
Drink lots of water or squash to avoid dehydration. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee.
Do not take any other medicines to treat diarrhoea without talking to a pharmacist or GP.
If you have severe diarrhoea for more than 24 hours, your contraception may not protect you from pregnancy. For example, if you take the combined contraceptive pill or the progestogen-only pill.
Check the pill packet for advice.
Indigestion
If you get repeated indigestion stop taking the medicine and contact your GP or pharmacist. To help ease the discomfort you could try an antacid.
Ringing in your ears (tinnitus)
If ringing in your ears lasts for more than 1 or 2 days, speak to your doctor as they may need to change your treatment.
Serious side effects
NSAIDs can cause serious side effects and allergic reactions.
Emergency action required: Call 112 or 999 or go to an emergency department (ED) if you have:
- severe chest or stomach pain
- weakness on one side of your body - this can be a sign of a stroke
- difficulty breathing or asthma symptoms that get worse
What we mean by severe pain
Severe pain:
- always there and so bad it's hard to think or talk
- you cannot sleep
- it's very hard to move, get out of bed, go to the bathroom, wash or dress
- you cannot work due to the pain
Moderate pain:
- always there
- makes it hard to concentrate or sleep
- you can manage to get up, wash or dress
Mild pain:
- comes and goes
- is annoying but does not stop you from doing things like going to work
Urgent advice: Ask for an urgent GP appointment if you:
- have black poo or blood in your pee
- vomit blood or dark particles
- have yellowing of your skin or white of your eyes - this can be a sign of liver problems
- have swollen ankles or are peeing less
- have severe indigestion, heartburn or pains in your stomach
- have a sore throat that keeps coming back, nosebleeds and infections - these can be signs of problems with your blood cells
- have a high temperature, stomach pain and are getting sick - these can be signs of inflammation of the pancreas
Severe allergic reaction
A serious allergic reaction (anaphylaxis) to NSAIDs is rare.
Emergency action required: Phone 112 or 999 or go to an emergency department (ED) if:
- you get a rash that is red, peeling, flaking or blistering
- you have trouble breathing
- your mouth, face, lips, tongue or throat start swelling
See the patient information leaflet that comes with your medicine for a full list of side effects.
Non-urgent advice: Find your patient information leaflet
Your patient information leaflet is the leaflet that comes with your medicine. You can find a digital version of the leaflet online.
Report side effects
You can report any suspected side effects to the Health Products Regulatory Authority (HPRA): report an issue - hpra.ie
Taking NSAIDs with other medicines
NSAIDs do not mix well with some medicines. Tell your GP or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.
Get medical advice before taking an NSAID if you're already taking medicine for:
- pain - such as another NSAID
- swelling - including steroids such as prednisolone or other anti-inflammatory medicines
- thinning the blood and to prevent blood clots - such as low-dose aspirin or warfarin
- autoimmune conditions, including arthritis or ulcerative colitis - such as ciclosporin
- making you pee more and sometimes to treat high blood pressure - such as furosemide
- mental health problems, including bipolar disorder and severe depression - such as lithium
- inflammatory conditions, including rheumatoid arthritis - such as methotrexate
- depression including an antidepressant called a selective serotonin reuptake inhibitor (SSRI) - such as citalopram and fluoxetine (Prozac)
- heart problems - such as digoxin
- diabetes - such as gliclazide, glimepiride or metformin
- HIV - such as zidovudine
- infections - such as antibiotics ciprofloxacin or levofloxacin
- high cholesterol - such as colestipol and cholestyramine
- seizures - such as phenytoin
Fact check
This content was fact checked by a pharmacist, a GP, and the National Medication Safety Programme (Safermeds).
