What are the contraindications to Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)?

From the Guidelines

NSAIDs are contraindicated in patients with a history of hypersensitivity or allergic reactions to these medications, including aspirin-exacerbated respiratory disease, severe heart failure, active gastrointestinal bleeding or ulceration, advanced kidney disease (GFR <30 ml/min), and during the third trimester of pregnancy. The use of NSAIDs should be avoided in several important clinical situations due to their potential risks 1. Some of the key contraindications to NSAIDs include:

• A history of hypersensitivity or allergic reactions to these medications, including aspirin-exacerbated respiratory disease
• Severe heart failure, as they can worsen cardiac function by promoting fluid retention
• Active gastrointestinal bleeding or ulceration due to their ability to inhibit prostaglandins that protect the gastric mucosa
• Advanced kidney disease (GFR <30 ml/min) as these medications can further reduce renal blood flow and worsen kidney function
• During the third trimester of pregnancy, as they may cause premature closure of the ductus arteriosus in the fetus
• Caution is also warranted in patients taking anticoagulants, as NSAIDs can increase bleeding risk, and in those with hypertension, as NSAIDs can elevate blood pressure 1. The mechanism behind many of these contraindications relates to NSAIDs' inhibition of cyclooxygenase enzymes, which affects prostaglandin synthesis throughout the body, impacting renal blood flow, gastric protection, and platelet function 1. It is essential to consider the potential risks and benefits of NSAID use in individual patients, particularly those with underlying medical conditions or taking other medications that may interact with NSAIDs 1.

From the FDA Drug Label

Naproxen tablets are contraindicated in patients with known hypersensitivity to naproxen. Naproxen tablets should not be given to patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs. NSAID medicines should never be used right before or after a heart surgery called a "coronary artery bypass graft (CABG)." Do not take an NSAID medicine: if you had an asthma attack, hives, or other allergic reaction with aspirin or any other NSAID medicine for pain right before or after heart bypass surgery Ibuprofen Tablets are contraindicated in the setting of coronary artery bypass graft (CABG) surgery

The contraindications to NSAIDs are:

• Known hypersensitivity to the NSAID
• History of asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs
• Right before or after heart bypass surgery (coronary artery bypass graft, CABG) 2, 2, 3

From the Research

Contraindications to Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

The following are contraindications to NSAIDs:

• Active gastrointestinal (GI) bleeding or ulceration 4, 5, 6, 7
• History of allergic reactions to NSAIDs, such as anaphylaxis, angioedema, or urticaria
• Severe renal impairment or kidney disease, as NSAIDs can worsen renal function 5
• Severe cardiovascular disease, including heart failure, coronary artery disease, or cerebrovascular disease, as NSAIDs can increase the risk of cardiovascular events 5
• Uncontrolled hypertension, as NSAIDs can increase blood pressure 5
• Pregnancy and lactation, as NSAIDs can have adverse effects on the fetus or baby
• Inflammatory bowel disease, such as Crohn's disease or ulcerative colitis, as NSAIDs can exacerbate the condition 8
• Concomitant use of other medications that increase the risk of GI bleeding or ulceration, such as anticoagulants, corticosteroids, or selective serotonin reuptake inhibitors (SSRIs) 4, 5, 6, 7

Special Considerations

Certain patient populations may require special consideration when using NSAIDs, including:

• Older adults, as they are at higher risk of GI bleeding and ulceration, as well as renal impairment and cardiovascular events 4, 5, 6, 7
• Patients with a history of GI disease, such as peptic ulcer disease or GI bleeding, as they are at higher risk of recurrent events 4, 5, 6, 7
• Patients with renal impairment or kidney disease, as NSAIDs can worsen renal function 5
• Patients with cardiovascular disease, as NSAIDs can increase the risk of cardiovascular events 5