From the Guidelines
NSAIDs are contraindicated in patients with active peptic ulcer disease, history of NSAID-induced asthma or urticaria, third trimester of pregnancy, severe heart failure, and advanced kidney disease, as well as those with a history of gastrointestinal bleeding or ulcers, hypertension, mild to moderate heart failure, liver disease, and concurrent use of anticoagulants like warfarin 1. When considering the use of NSAIDs, it is essential to weigh the potential benefits against the risks, particularly in patients with certain medical conditions. The contraindications for NSAIDs can be categorized into absolute and relative contraindications. Absolute contraindications include:
- Active peptic ulcer disease
- History of NSAID-induced asthma or urticaria
- Third trimester of pregnancy
- Severe heart failure
- Advanced kidney disease Relative contraindications, where caution is needed, include:
- History of gastrointestinal bleeding or ulcers
- Hypertension
- Mild to moderate heart failure
- Liver disease
- Concurrent use of anticoagulants like warfarin
- Concurrent use of corticosteroids
- Advanced age (especially over 65)
- Inflammatory bowel disease
- Second trimester of pregnancy Specific NSAIDs like aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib (Celebrex), and diclofenac should be avoided in patients with these conditions, as they can cause gastric irritation and bleeding, worsen kidney function, increase cardiovascular risk, and potentially cause severe allergic reactions in sensitive individuals 1. The use of NSAIDs can lead to significant adverse effects, including dyspepsia, abdominal pain, GI discomfort, GI bleeding, cardiovascular complications, hepatic complications, impaired renal function, clotting problems, and respiratory issues, such as aspirin-exacerbated respiratory disease 1. It is crucial to consult with a healthcare provider before taking NSAIDs if you have any of these conditions, as they can help determine the best course of treatment and minimize the risk of adverse effects 1.
From the FDA Drug Label
Do not take NSAIDs: • if you have had an asthma attack, hives, or other allergic reaction with aspirin or any other NSAIDs. • right before or after heart bypass surgery Ibuprofen Tablets are contraindicated in the setting of coronary artery bypass graft (CABG) surgery
The contraindications for NSAIDs are:
- A history of asthma attack, hives, or other allergic reaction with aspirin or any other NSAIDs
- Right before or after heart bypass surgery (coronary artery bypass graft (CABG) surgery) 2, 3, 4
From the Research
Contraindications for NSAIDs
The following are contraindications for NSAIDs:
- Gastrointestinal damage, including major bleedings from peptic ulcer 5
- Cardiovascular events, both fatal and nonfatal, associated with the use of NSAIDs 5, 6
- Increased risk of adverse CV events, myocardial infarction, heart failure, and cerebrovascular events in patients with and without CV diseases 6
- Hepatotoxicity and kidney damage 7
- Exacerbation of heart failure 7
- Concomitant use of several systemic NSAIDs, which is associated with an excess risk of adverse effects such as hepatic injury, acute renal failure, and gastrointestinal bleeding 8
- Upper gastrointestinal bleeding associated with the use of NSAIDs, with newer versus older agents having different risk estimates 9
- History of peptic ulcer and/or upper gastrointestinal bleeding 9
- Concomitant use of antiplatelet drugs 9
Patient-Specific Contraindications
Certain patient populations may be at higher risk for adverse effects from NSAIDs, including:
- Patients with overt heart disease, such as coronary artery disease and heart failure 5
- Patients with cardiovascular disease, chronic kidney disease, hypertension, heart failure, or liver cirrhosis 7
- Patients with increased cardiovascular, liver, and kidney risk 7
Drug-Specific Contraindications
Different NSAIDs have varying risk profiles, including:
- Ketorolac, which is associated with the highest risk estimate of upper gastrointestinal bleeding 9
- Newer NSAIDs, such as aceclofenac, celecoxib, dexketoprofen, meloxicam, nimesulide, and rofecoxib, which have different risk estimates for upper gastrointestinal bleeding 9
- Naproxen and low-dose ibuprofen, which may have a lower CV risk profile 6