Daily NSAID Use for One Year: Safety Considerations

Major Risks of Long-Term NSAID Use

Upper GI ulcers, bleeding, or perforation occur in approximately 1% of patients treated for 3-6 months, and in about 2-4% of patients treated for one year 1, 2
Risk is higher in older adults (one-year risk is 1 in 110 for adults older than 75 years compared to 1 in 2,100 for adults younger than 45) 1
The American Academy of Family Physicians recommends combining NSAIDs with a proton pump inhibitor (PPI) or misoprostol to prevent GI complications 2
The American Academy of Family Physicians suggests considering celecoxib (Celebrex) with a PPI if no elevated cardiovascular risk 1

NSAIDs can worsen hypertension (mean blood pressure increase of 5 mm Hg) 2
The American Heart Association recommends avoiding NSAIDs in patients with recent myocardial infarction 3

About 2% of patients stop taking NSAIDs due to renal complications 2
The American Academy of Family Physicians notes that long-term NSAID use can result in renal papillary necrosis and other kidney injury in patients with impaired renal function, hypovolemia, liver dysfunction, or salt depletion 4

The American Academy of Family Physicians recommends considering patient-specific risk factors, including age, history of GI bleeding or ulcers, concurrent use of anticoagulants, corticosteroids, or aspirin, cardiovascular disease, renal impairment, and hypertension 1, 2, 4
The National Comprehensive Cancer Network recommends adding gastroprotective agents, such as PPI or misoprostol, for high GI risk patients 4, 5
The American Academy of Family Physicians suggests monitoring for complications, including regular assessment of blood pressure and periodic evaluation of renal function in high-risk patients 3, 4

The American College of Rheumatology recommends considering short-term rather than continuous use of NSAIDs 6
The National Comprehensive Cancer Network suggests using acetaminophen as an alternative to NSAIDs, with caution regarding hepatic toxicity, and limiting it to 3g or less per day 5
The National Comprehensive Cancer Network recommends considering topical NSAIDs for localized pain when appropriate 7

The American Heart Association recommends avoiding COX-2 inhibitors in patients with cardiovascular risk 2
The American Academy of Family Physicians suggests avoiding NSAIDs in patients with congestive heart failure 2
The American Academy of Family Physicians recommends avoiding NSAIDs in patients with renal disease and using caution when combining with medications that potentially decrease renal function 2