What Are NSAIDs and How Do They Work?
Nonsteroidal anti-inflammatory drugs (NSAIDs) are a class of medication commonly used to relieve pain, reduce fever, and decrease inflammation [1.4.5]. They are available both over-the-counter (e.g., ibuprofen, naproxen sodium) and by prescription (e.g., celecoxib, diclofenac) [1.3.2, 1.2.5].
NSAIDs work by blocking enzymes called cyclooxygenase, or COX [1.2.5]. There are two main types of this enzyme:
- COX-1: This enzyme is involved in protecting the stomach lining from its own acid [1.5.4].
- COX-2: This enzyme is produced in response to injury or inflammation and is what causes sensations of pain [1.2.5, 1.5.4].
Traditional NSAIDs like ibuprofen and naproxen are non-selective, meaning they block both COX-1 and COX-2 enzymes. This dual action is why they can relieve pain but also cause stomach issues as a side effect [1.6.1].
The Dangers of Daily Use: A System-by-System Breakdown
While generally safe for short-term use, taking NSAIDs daily for an extended period—defined as more than three times a week for over three months—can lead to serious health complications [1.5.1]. The U.S. Food and Drug Administration (FDA) has issued warnings that the risk of heart attack or stroke can occur as early as the first weeks of using an NSAID and may increase with longer use and higher doses [1.3.3].
Gastrointestinal (GI) System
The most common side effects of long-term NSAID use are gastrointestinal [1.2.3]. Because NSAIDs inhibit the COX-1 enzyme, they reduce the production of prostaglandins that protect the stomach lining [1.2.4]. This can lead to:
- Stomach Ulcers and Bleeding: Chronic NSAID use is a leading cause of peptic ulcers [1.6.4]. Up to 30% of regular users develop ulcers, and 2-4% may experience complications like bleeding or perforation per year [1.6.3, 1.6.1].
- Dyspepsia: Symptoms like heartburn, stomach pain, gas, and nausea are common, affecting 10% to 60% of users [1.2.3, 1.6.1].
- Lower GI Damage: NSAIDs can also harm the small and large intestines, causing inflammation, bleeding, and, in rare cases, perforation [1.6.5].
Cardiovascular System
In 2015, the FDA strengthened its warning about the cardiovascular risks associated with non-aspirin NSAIDs [1.3.1]. Daily use can increase the risk of:
- Heart Attack and Stroke: All NSAIDs, except for aspirin, carry a boxed warning for an increased risk of heart attack and stroke, which can be fatal [1.2.2, 1.3.2]. The risk exists even for people without pre-existing heart conditions but is higher for those who do [1.3.3].
- High Blood Pressure: NSAIDs can raise systolic blood pressure by approximately 5 mmHg and can interfere with the effectiveness of blood pressure medications [1.3.4, 1.3.5].
- Heart Failure: All NSAIDs can double the risk of hospitalization for heart failure by causing fluid and sodium retention [1.3.4, 1.7.2].
Renal (Kidney) System
Prostaglandins help maintain blood flow to the kidneys. By inhibiting them, NSAIDs can reduce blood flow, potentially causing damage [1.8.1]. Long-term risks include:
- Acute Kidney Injury (AKI): The risk of AKI can double within 30 days of starting an NSAID, especially in vulnerable individuals [1.3.5, 1.8.2].
- Chronic Kidney Disease (CKD): One study found that long-term NSAID use (≥90 days) in people with hypertension increased the risk of developing CKD by 32% [1.4.4].
- Fluid Retention (Edema): Swelling in the legs and ankles can occur because the kidneys' ability to manage fluid is impaired [1.2.3, 1.8.3].
Comparison of Common Over-the-Counter NSAIDs
Ibuprofen and naproxen are two of the most common OTC NSAIDs. While they work similarly, there are key differences in their duration and risk profiles.
| Feature | Ibuprofen (Advil, Motrin) | Naproxen Sodium (Aleve) |
|---|---|---|
| Duration of Action | Short-acting (4-6 hours) [1.10.1] | Long-acting (8-12 hours) [1.10.2] |
| Dosing Frequency | Every 4-6 hours [1.10.1] | Every 8-12 hours [1.10.1] |
| Gastrointestinal Risk | May have a lower risk of GI bleeding than naproxen [1.10.1]. | Associated with a higher risk of GI side effects due to its longer duration [1.10.4]. |
| Cardiovascular Risk | Risk increases with dose; higher doses are linked to increased cardiovascular events [1.10.4]. | Some studies suggest it has a lower cardiovascular risk profile compared to other NSAIDs, but a risk still exists [1.5.3, 1.10.4]. |
Who Is at Highest Risk?
Certain individuals are more susceptible to the adverse effects of daily NSAID use [1.3.2, 1.11.4]:
- Adults over age 65
- Individuals with a history of peptic ulcers or stomach bleeding
- People with pre-existing cardiovascular disease, high blood pressure, or heart failure
- Those with kidney disease or diabetes
- Patients taking certain medications, including anticoagulants (blood thinners), corticosteroids, and some antidepressants (SSRIs) [1.3.4, 1.4.2].
Safer Alternatives and Strategies for Managing Chronic Pain
If you take NSAIDs daily, it is crucial to speak with a healthcare provider to weigh the risks and benefits [1.4.1]. Safer pain management strategies include:
- Use the Lowest Dose for the Shortest Time: This is the most important principle for reducing NSAID risks [1.4.2, 1.4.5].
- Acetaminophen (Tylenol): A good alternative for pain and fever relief, though it lacks anti-inflammatory effects. It carries a risk of liver damage at high doses [1.9.1, 1.9.4].
- Topical NSAIDs: Gels and creams (like Voltaren) can relieve localized pain with a much lower risk of systemic side effects [1.5.2, 1.8.1].
- Non-Pharmacological Therapies: Physical therapy, exercise, massage, acupuncture, and heat/cold application can be effective for managing chronic pain [1.5.3, 1.9.3].
Find out more about alternatives from the Mayo Clinic.
Conclusion: Balancing Relief with Risk
NSAIDs are effective medications for acute pain and inflammation. However, the answer to 'What happens if you take NSAIDs every day?' is complex and fraught with potential dangers. Daily, long-term use significantly elevates the risk of serious gastrointestinal, cardiovascular, and kidney problems [1.2.1]. This is especially true for older adults and those with underlying health conditions [1.2.2]. It is essential for anyone considering long-term NSAID therapy to do so only under the guidance of a healthcare professional who can monitor for side effects and explore safer alternatives to ensure that the benefits of pain relief outweigh the considerable risks [1.2.5].
