Adverse effect	Preventive or therapeutic measures		Risk of adverse effect
Dyspepsia, abdominal pain, GI discomfort	Combine NSAID with a PPI or histamine H2 blocker		Prevalence is 10 to 20 percent 4
	Poor correlation with clinically significant ulcerations
GI bleeding	Avoid NSAIDs in persons with history of NSAID-associated upper GI tract bleeding		Dependent on age and patient history One-year risk is one in 2,100 adults younger than 45 and one in 110 adults older than 755 Risk of bleeding recurrence is 5 percent in first six months in persons with history of upper GI tract bleeding taking NSAIDs2
		or
	Combine NSAID with a PPI or misoprostol (Cytotec); misoprostol poorly tolerated because of GI effects
		or
	Celecoxib (Celebrex), possibly with a PPI or misoprostol; avoid if any elevated risk of myocardial infarction
Cardiovascular complications (worsening hypertension, myocardial infarction)	Avoid COX-2 inhibitors in persons at risk of cardiovascular events		Varying results; one meta-analysis reports an excess of 3.5 cardiac ischemic events per 1,000 persons taking celecoxib compared with placebo 2
	Avoid NSAIDs in persons with congestive heart failure Use NSAIDs with caution in persons with hypertension		Mean blood pressure increase is 5 mm Hg with NSAID use 2
Hepatic complications (transaminitis, synthetic impairment)	Avoid NSAIDs in persons with cirrhosis because of the potential for hematologic and renal complications		Primary hepatic complications are rare and usually reversible
	Avoid NSAIDs with more potential for hepatic problems, such as sulindac (Clinoril) and diclofenac (Cataflam)
Impaired renal function	Avoid NSAIDs in persons with renal disease		Because of renal complications, 2 percent of persons stop taking NSAIDs6
	Use NSAIDs with caution when combining with other medications that potentially decrease renal function, such as angiotensin-converting enzyme inhibitors and beta blockers
Clotting problems contributing to significant bleeding	Avoid NSAIDs in persons with platelet defects or thrombocytopenia		—
	Avoid combining NSAIDs with anticoagulants		Risk of GI bleeding increases three to six times if NSAIDs used with anticoagulants2
	If NSAIDs are necessary in persons taking anticoagulants, expect an increase in INR		INR increases up to 15 percent if NSAIDs used concurrently with anticoagulants2
	Avoid daily low-dose aspirin if cardiovascular risk is low (less than 3 percent annual risk)		—
Respiratory (aspirin-exacerbated respiratory disease)	Use NSAIDs and aspirin with caution in persons with asthma, especially those with nasal polyps or recurrent sinusitis		Prevalence of aspirin-exacerbated respiratory disease is 0.07 percent in general population and up to 21 percent in adults with asthma7
	Aspirin desensitization (limited data)
Prolonged pregnancy or labor, fetal effects from antiplatelet activity	Avoid NSAIDs toward end of pregnancy (six to eight weeks before term)		Based on case reports8–12