NSAIDs and arthritis: Frequently asked questions

NSAIDs are commonly used painkillers for joint pains and aches. This page answers the most frequently asked questions about NSAIDs, including how they work and how you can use them safely if you have arthritis. 

What are NSAIDs and how do they work for arthritis?

NSAIDs (non-steroidal anti-inflammatory drugs) are medicines that can reduce pain and inflammation. They may help with joint pain, swelling and stiffness, making movement and daily activities easier.  

They are available in different forms, such as tablets, gels and sprays. Some are available to buy at pharmacies or shops, while others can only be prescribed by your doctor. Common examples include ibuprofen, naproxen, diclofenac, celecoxib and etoricoxib. 

NSAIDs help control symptoms, but they don't treat every underlying cause of arthritis. In inflammatory arthritis, such as rheumatoid arthritis, other medicines are usually needed to control the disease and protect the joints.  

How long does it take for NSAIDs to start working?

Some pain relief may start within an hour or a few hours. How quickly it works can depend on the NSAID, the dose and whether you use a tablet, gel or another form of the medicine. If you take NSAID tablets, taking them with food may also affect how quickly they work. 

Improvement in inflammation, swelling and stiffness can take longer – sometimes several days. The full anti-inflammatory benefit may take up to around 2 weeks. Gels and creams may also need repeated applications before the full effect is clear.  

Don't take extra tablets or apply extra gel if you don’t feel the effects straight away. If there is no clear improvement after an agreed treatment period, speak to your pharmacist, GP or healthcare professional. They may need to review the diagnosis, treatment plan or NSAID choice.  

Are NSAIDs safe?

NSAIDs are helpful and safe for many people, but they are not suitable for everyone.  

People with certain health conditions may be more likely to have side effects. This includes people who have stomach ulcers, kidney disease, heart disease, liver problems, high blood pressure, circulation problems, bleeding problems or asthma.  

Serious side effects of NSAIDs are very rare, but may include stomach ulcers or bleeding, raised blood pressure, fluid retention, worsening heart failure, heart attack or stroke, reduced kidney function, worsening asthma and allergic reactions.  

You may be prescribed a medicine with NSAID tablets or capsules to help prevent stomach problems. But it does not reduce heart or kidney risks.  

Speak to your doctor or pharmacist before starting an NSAID if you are older, pregnant or trying for a baby, have important medical conditions, or take several other medicines. They can make sure it's safe for you to take. 

Can I take NSAIDs every day?

It depends. Taking NSAIDs every day may be appropriate for some people but should be agreed and reviewed with your healthcare professional. Daily NSAID treatment may be useful during an arthritis flare-up, while another arthritis medicine starts working or when symptoms are affecting your everyday life. The usual aim is to use the lowest dose that works for the shortest time needed.  

If longer-term treatment is needed, your healthcare professional may want to regularly monitor you. They may check your blood pressure, kidney function, full blood count and sometimes liver tests.  

Ask for a review with your healthcare team if you find you need an over-the-counter NSAID repeatedly, need it for longer than the label advises, increase the dose, or your pain is not well controlled. 

You should also seek advice if you develop symptoms such as swelling, breathlessness, stomach problems, peeing less often, unusual tiredness, bruising or bleeding.  

Should I use NSAID tablets or gels, and can I use them together?

NSAID gels and creams mainly work around the joint where they are applied. They can be useful for targeting pain in joints close to the skin, such as the knee or hand. NSAID gels are recommended for knee osteoarthritis and should be considered for osteoarthritis in other joints before moving to NSAID tablets or capsules.  

NSAID tablets or capsules work throughout the body and may be more useful if pain is widespread or deeper. But they are more likely to cause side effects that affect the whole body. If a gel or cream is not enough, an NSAID tablet may be considered after reviewing other possible risks.  

You should not usually use an NSAID tablet and an NSAID gel together unless your doctor or healthcare team advises you to.  This is because you’ll be using more NSAID overall, which could increase the risk of side effects. 

Can I take NSAIDs with paracetamol or other painkillers?

You can sometimes take paracetamol or other painkillers with NSAIDs. This is because they are not NSAIDs, so work differently. But always check the dose and whether it’s right for you with your pharmacist or healthcare professional. This is particularly important if you have liver disease, drink alcohol regularly, or take other medicines that contain paracetamol.  

Do not take 2 NSAIDs together, such as ibuprofen with naproxen, or diclofenac with ibuprofen, unless your doctor or healthcare team specifically tells you to.  

Some cold, flu, sleep, period and combination pain products contain multiple medicines like NSAIDs or paracetamol, so always check the active ingredients or check with your pharmacist.  

Opioids like codeine can cause drowsiness, constipation, dependence and other side effects, so only use them as directed. 

Can I take NSAIDs with my other medicines, supplements or herbal remedies?

Ask your pharmacist or prescriber to check your full medicine list before starting an NSAID. This includes prescribed medicines, over-the-counter medicines, vitamins, supplements and herbal remedies.  

NSAIDs can interact with blood thinners, aspirin, steroids, SSRI or SNRI antidepressants like sertraline or duloxetine, blood pressure medicines, diuretics, lithium, digoxin, methotrexate, ciclosporin and tacrolimus. These interactions may increase bleeding risk, affect kidney function, change blood pressure control or increase the level of some medicines in the body.  

Herbal or natural products can interact with NSAIDs. Always check with your doctor or pharmacist before using them.  

Can I drink alcohol while on NSAIDs? 

You should limit how much alcohol you drink while taking NSAIDs. Drinking too much alcohol can irritate the stomach and increase the risk of bleeding. It can also affect your liver.  

Government guidelines advise drinking no more than 14 units per week, spread evenly across 3 or more days. This is around 6 pints of average-strength beer or medium glasses of wine over a week. 

Should I take an NSAID before exercise? 

Do not take an extra NSAID just to prevent discomfort during exercise or to push through new pain. NSAIDs can reduce pain signals without explaining why the pain is happening, and there is limited evidence that they prevent exercise soreness or improve performance.  

Regular exercise is an important part of managing arthritis, but it should be built up gradually. The risk of side effects from NSAIDs is higher during prolonged or intense exercise because the kidneys may already be under strain.  

If an NSAID is part of your regular treatment plan, ask your doctor or physiotherapist how best to use it around exercise. Seek advice for sharp, unusual, rapidly worsening, hot or very swollen joint pain.  

Can I take NSAIDs if I'm pregnant, trying for a baby or breastfeeding?  

If you’re trying for a baby, taking an NSAID, especially ibuprofen, for a long time or at a high dose may delay or prevent ovulation. This can make it more difficult to get pregnant. The effect is usually reversible after stopping.  

If you are having difficulty conceiving, discuss regular NSAID use with your doctor or pharmacist. Do not stop prescribed treatment without agreeing an alternative plan with your healthcare team.  

If you’re pregnant, you should avoid taking NSAIDs after 20 weeks unless a healthcare professional specifically recommends them. This is because they can cause kidney problems in the baby and low amniotic fluid.  

If an NSAID is needed between 20 and 28 weeks, it should be prescribed by your healthcare team and used at the lowest effective dose for the shortest possible time. You may also need additional monitoring during your pregnancy if you need an NSAID for more than a few days. 

NSAIDs should not be taken after 28 weeks because they can cause additional risks to the baby’s heart circulation.  

Low-dose aspirin prescribed for a specific reason in pregnancy is different and should not be started or stopped without advice from your healthcare team. 

If you're breastfeeding, ibuprofen or diclofenac are generally preferred if your baby is full-term and healthy. This is because only very small amounts pass into breast milk. Celecoxib may also be considered in some cases.  

What side effects of NSAIDs should I look out for? 

Most side effects of NSAIDs are mild. Common side effects of NSAIDs include indigestion, stomach pain, nausea, vomiting, loose poo (diarrhoea), dizziness, headache and rash. Gels and creams may also cause skin dryness, redness, itching or irritation.  

Get urgent help if you develop:  

• chest pain  
• severe shortness of breath  
• weakness on one side 
• slurred speech 
• swelling of the face, lips, tongue or throat 
• wheezing  
• difficulty breathing  
• vomiting blood or material that looks like coffee grounds  
• black tar-like stools  
• severe blistering rash.  

Stop the NSAID and seek prompt medical advice if you: 

• have severe or ongoing stomach pain 
• have blood in your pee 
• have dark pee 
• are peeing much less than usual 
• have swelling of the hands, feet or ankles 
• have unexplained weight gain, worsening breathlessness 
• have yellow skin or eyes 
• feel unusually fatigued or weak 
• have ongoing nausea 
• have unusual bruising, bleeding or paleness.  

You're also more likely to get side effects during hot weather, if you're vomiting or have loose poo (diarrhoea), or you're dehydrated. This risk of side effects is also higher when you take higher doses, use NSAIDs for a long time or you are older.  

Speak to your pharmacist, GP or healthcare professional if side effects don’t go away or affect your daily life. 

What are the alternatives if NSAIDs don't help or I can't take them?

The best alternative depends on the type of arthritis and why NSAIDs are not suitable.  

For osteoarthritis, the main treatments are regular exercise built up gradually and gentle strengthening or stretching exercises. Losing weight, if needed, can reduce pressure on joints and improve pain. Walking aids, splints, braces, heat or cold packs and capsaicin cream may also help some people.  

You can take paracetamol occasionally for short-term relief when other options are unsuitable, although it may not help everyone. Your healthcare professional may consider a steroid injection into the joint for short-term relief if other treatments are not suitable or have not helped. 

For inflammatory arthritis, such as rheumatoid arthritis, ongoing swelling, morning stiffness or repeated flare-ups may mean the underlying disease is not well controlled.  

If this is the case, you may need a review of your disease-modifying treatment, such as DMARDs, biologic medicines, or targeted therapies, rather than simply stronger painkillers. You may also be prescribed steroids for a short period to help reduce inflammation. 

Contact your rheumatology team if you get frequent flare-ups, your joint function is getting worse, or you're using NSAIDs more often.  

Sources: 

• NICE guideline NG226: Osteoarthritis in over 16s: diagnosis and management. 
• NICE guideline NG100: Rheumatoid arthritis in adults: management. 
• NHS: Non-steroidal anti-inflammatory drugs (NSAIDs). 
• NICE Clinical Knowledge Summaries: NSAIDs prescribing issues. 
• MHRA Drug Safety Update: NSAIDs — potential risks following prolonged use after 20 weeks of pregnancy. 
• NHS Specialist Pharmacy Service: Using NSAIDs during breastfeeding. 

Last review: October 2026 

Next review: October 2029