NSAIDs, or non-steroidal anti-inflammatory drugs, are a class of anti-inflammatory medications. You can get them as an over-the-counter medicine or with a prescription. They work well at reducing fever, pain and inflammation. Aspirin, naproxen sodium (Aleve, Naprosyn), and ibuprofen (Advil, Motrin) are the most common NSAIDs.

Millions of Americans take these medicines every day. They can be very helpful in managing the pain and inflammation caused by arthritis and other musculoskeletal disorders. Most people can take them without any problems. But is this the case for everyone?

Medical research shows that while they are generally safe, NSAIDS can be harmful to people who have pre-existing conditions or if the drugs are used too much . Are NSAIDs bad for kidneys? Do they cause stomach trouble, bleeding and hypertension?

How NSAIDs affect kidney function

The most common problem  caused by NSAIDs is gastrointestinal trouble, including indigestion, bleeding and ulcers. The second most-common problem is damage to the kidneys.

NSAIDs work  by blocking certain enzymes that are part of the body’s process for regulating pain and inflammation, which is the cause of many types of pain. (This is why NSAIDs are called anti-inflammatory drugs.) Those enzymes also help regulate kidney function.

Your kidneys contain millions of tiny filters called nephrons. The kidneys together filter about a half cup of blood every minute. One of their jobs is to remove wastes and extra fluid while regulating the levels of water, minerals, and salts in your body. Excess water and wastes are sent to the bladder as urine.

The enzymes that NSAIDs block to reduce inflammation also help to regulate blood pressure in the kidneys. NSAIDs decrease blood flow through the kidneys, which is why they have the potential to cause nephrotoxicity, the reduction of renal function due to a toxin, and renal damage.

Those enzymes also help to protect the lining of your stomach and regulate blood clotting. This is why NSAIDs increase the risk of bleeding ulcers, gastrointestinal problems and high blood pressure.

For people  without kidney disease, occasional use of NSAIDs at the recommended dosage is safe — unless they are allergic to NSAIDs. High doses of NSAIDs and/or long-term use of them can cause renal impairment as well as other problems. In most cases, discontinuing NSAIDs can reverse the damage. However, continued use after the development of kidney damage or nephropathy (deterioration of the kidneys) may lead to chronic kidney disease.

Risk factors to consider

NSAID side effects are more common in individuals aged 65 years and older. People with the following conditions are also at a greater risk from use of NSAIDs:

• Asthma
• Gastrointestinal problems (such as ulcers or bleeding)
• Heart problems
• High blood pressure
• Diabetes
• Kidney disease

Another thing to remember is that NSAIDs can interact with other medications , such as blood thinners, ACE inhibitors, ARBs, and diuretics, potentially causing additional complications.

NSAIDs  can increase blood pressure in individuals with hypertension due to the drug’s interference with blood pressure in the kidneys. NSAIDs make these people less responsive to antihypertensive drugs.

Research shows that NSAID use increases the incidence of cardiovascular and bleeding events in heart attack patients, compared to those who do not get NSAID treatment. In particular, patients taking NSAIDs had a risk of bleeding that was more than four times higher than that of individuals not taking NSAIDs.

Safer alternatives for kidney health

To protect renal health when using these pain relief products, take the smallest effective dose for the shortest duration required. Routine renal function tests  can find early indicators of kidney disorders, allowing for timely intervention and modifications in drug use.

Acetaminophen  (Tylenol) is not an NSAID and it has minimal direct impact on the kidneys, although people with liver trouble may be urged to avoid it. It also does not cause gastrointestinal side effects (unlike NSAIDs), making it a better option for those with stomach sensitivities.

For people with kidney trouble or at risk of developing kidney damage, acetaminophen is a better option than NSAIDs such as Aleve, Advil, Motrin, Voltaren, and Celebrex.

Aspirin, despite being an NSAID, is a safer alternative to other NSAIDs when taken in small doses. However, you should always take  it with food because it can irritate the gastrointestinal tract.

Adopting a well-rounded diet rich in antioxidants can enhance your overall wellness and reduce the need for nonsteroidal anti-inflammatory drugs. This includes limiting sodium  consumption and maintaining adequate hydration. Natural remedies  that are good alternatives to NSAIDS include turmeric, which offers strong anti-inflammatory properties, and the omega-3 fatty acids found in fish oil, which can also help manage chronic pain and inflammation.

When to consult a healthcare provider

Clearly, it’s important to seek professional advice for pain management, so you can choose the safest and most effective medication.

It also is important to keep an eye out for symptoms  of possible renal toxicity when taking NSAIDs. Reduced urine production, ankle or leg swelling, and unexplained lethargy are all signs of renal failure. See a doctor right away if you experience any of these symptoms; detecting kidney disease early prevents additional damage.

Consult a specialist from the family medicine team at Florida Medical Clinic Orlando Health if you’re worried about your kidney health while taking nonsteroidal anti-inflammatory drugs. Our family medicine specialists will carefully monitor your medications as part of your comprehensive treatment plan to protect your kidneys. We are committed to protecting your health by using cutting-edge diagnostic equipment and a team-based approach to treatment. Get the individualized attention you need by making an appointment with a trained professional now.

Meet Faizan Master, MD

Dr. Faizan Master is a board-certified Family Medicine physician dedicated to providing high-quality, compassionate care to adults at every stage of life. He has a clinical focus on preventive care, chronic disease management, geriatric medicine, women’s health, and mental health conditions such as anxiety and depression, and prioritizes long-term relationships built on trust, respect, and open communication.

Dr. Master believes that every patient deserves to feel heard, valued, and empowered to take an active role in their care.

Request an appointment with Dr. Master by calling 813-899-2015.