NSAID Contraindications and Precautions

High-Risk Patients Who Should Avoid NSAIDs

Patients with a history of GI complications, such as prior ulcer bleeding, should avoid NSAIDs completely due to the high risk of recurrent bleeding, as recommended by the American College of Gastroenterology 1
Patients receiving anticoagulants should avoid NSAIDs due to the potentially disastrous consequences of GI bleeding, according to the American College of Gastroenterology 1

Patients with pre-existing kidney disease should avoid NSAIDs to prevent acute renal failure, as advised by the American Academy of Family Physicians 2
Patients with congestive heart failure should avoid NSAIDs due to the risk of worsening renal function, according to the American Academy of Family Physicians 2
Patients with liver cirrhosis should avoid NSAIDs due to the risk of renal failure, as recommended by the American Academy of Family Physicians 2
Patients with compromised fluid status, such as hypovolemia or dehydration, are at increased risk for NSAID-induced kidney injury, according to the American Academy of Family Physicians 2
Patients over 60 years have an increased risk of renal complications with NSAIDs, as noted by the American Geriatrics Society 3

Patients with multiple GI risk factors, such as older age, high-dose NSAIDs, history of ulcer, concomitant use of corticosteroids, anticoagulants, or SSRIs, should exercise caution when taking NSAIDs, as recommended by the American College of Gastroenterology 2
Very high-risk patients, such as those with recent ulcer complications, should avoid NSAIDs altogether, according to the American College of Gastroenterology 1

NSAIDs can worsen hypertension, with an average increase of 5 mm Hg, and should be used with caution in patients with treatment-resistant hypertension, as noted by the American Heart Association 5
Patients with high cardiovascular risk should avoid NSAIDs when possible, according to the American Heart Association 5

Taking more than one NSAID simultaneously significantly increases the risk of adverse effects, as warned by the American Academy of Family Physicians 3
NSAIDs can interact with antihypertensives, particularly ACE inhibitors and angiotensin receptor blockers, reducing their effectiveness and increasing renal risk, according to the American Academy of Family Physicians 2

Patients with moderate GI risk should use proton pump inhibitors (PPIs), double-dose histamine H2 blockers, or misoprostol with NSAIDs, as recommended by the American College of Gastroenterology 2
Consider monitoring serum creatinine levels after initiation of NSAID therapy in at-risk patients, particularly those taking ACE inhibitors and angiotensin receptor blockers, as advised by the American Academy of Family Physicians 2