MINI NURSES | PHARMACOLOGY & MEDICATION SAFETY
Pain relief is only one part of the assessment. Before giving an NSAID, check what else the patient has taken and what could make the medicine unsafe.
Ibuprofen, diclofenac and naproxen are familiar names, but familiarity can make their risks easy to overlook. A patient may take one medicine at home, buy another under a different brand name and receive a prescription without recognising that the products belong to the same drug class. For nurses, the useful question is not simply “Have you taken painkillers?” It is “Which medicine, what strength, how much and when?”
What are NSAIDs?
Non-steroidal anti-inflammatory drugs are used to reduce pain, inflammation and fever. Depending on the medicine and clinical situation, they may be used for arthritis, painful periods, musculoskeletal injuries and other painful conditions. Products come in several forms, including oral preparations and topical gels. Availability and prescribing requirements vary by country. [1]
How they work: the COX connection
NSAIDs inhibit cyclooxygenase enzymes, reducing the formation of prostaglandins involved in pain and inflammation. Many inhibit both COX-1 and COX-2, while medicines such as celecoxib are more selective for COX-2. Prostaglandins also have protective roles, including in the stomach and renal circulation. This helps explain why reducing pain can come with gastrointestinal and kidney risks. COX-2 selectivity does not make a medicine free of serious adverse effects. [2]
Common examples to recognise
| Generic medicine | Useful distinction |
|---|---|
| Ibuprofen | Check for it in both single-ingredient and combination products. |
| Diclofenac | The exact formulation and route matter; check the product label. |
| Naproxen | Another NSAID, not an automatic additional painkiller alongside ibuprofen. |
| Mefenamic acid and indomethacin | Recognise the generic names during medication reconciliation. |
| Celecoxib and etoricoxib | COX-2-selective medicines still require individual risk assessment. |
| Aspirin | Low-dose antiplatelet use is a distinct prescribing purpose. Do not stop prescribed aspirin independently. |
This is a recognition guide, not a dosing chart. Doses, intervals, age restrictions and maximum treatment durations are product-specific. Never substitute milligram-for-milligram between different NSAIDs.
Three major risks nurses should connect to the history
1. Gastrointestinal ulceration and bleeding
NSAIDs can cause ulcers and bleeding, sometimes without early warning. Risk is greater with factors such as older age, a previous ulcer or bleeding, and medicines that increase bleeding risk. Vomiting blood or passing black, tar-like stool needs urgent medical assessment. Taking a tablet with food may reduce stomach upset, but it does not guarantee protection from serious bleeding. [3]
2. Kidney injury, particularly during dehydration
A patient with vomiting, diarrhoea, poor fluid intake or low blood pressure needs particular attention. NSAIDs can contribute to acute kidney injury when kidney blood flow is already reduced. Ask about kidney disease and recent illness, assess hydration and report reduced urine output or other concerning changes. [4] Combining an NSAID with an ACE inhibitor or ARB and a diuretic can further increase renal risk; flag the combination for review rather than independently stopping all the patient’s medicines. [5]
3. Cardiovascular harm
Non-aspirin NSAIDs can increase the risk of heart attack and stroke. A history of cardiovascular disease, hypertension or heart failure matters when treatment is selected. Chest pain, sudden one-sided weakness or slurred speech requires emergency assessment. Do not dismiss these symptoms because the medicine was bought without a prescription. [3]
Pregnancy: check before use
The FDA advises avoiding NSAIDs from about 20 weeks of pregnancy unless specifically directed by a healthcare professional, because fetal kidney effects can reduce amniotic fluid. From around 30 weeks, premature closure of the fetal ductus arteriosus is an additional concern. The FDA warning makes an exception for prescribed low-dose 81 mg aspirin for certain pregnancy-related conditions. A patient taking aspirin under an obstetric plan should seek advice rather than stop it independently. [6]
Before administration: a practical nursing check
Confirm the prescription, patient, indication, formulation, route, dose and timing. Ask about prior reactions to aspirin or NSAIDs, including wheezing or swelling, and clarify any relevant asthma history. Review previous gastrointestinal bleeding, kidney disease, hydration, cardiovascular history and possible pregnancy. Ask the patient to name or show every medicine already taken, including shop-bought pain, cold and flu preparations. Do not assume that different brand names mean different drug classes.
Review the monitoring plan. The NHS Specialist Pharmacy Service advises considering baseline blood pressure, renal function and full blood count, with follow-up tailored to treatment and risk. Haemoglobin monitoring is particularly relevant when gastrointestinal risk is high. Check available results and escalate abnormalities or missing monitoring when it matters for safe administration. [7]
Interactions worth checking
Other NSAIDs, anticoagulants, corticosteroids, some antidepressants and blood-pressure medicines can interact or increase adverse-effect risks. Check with the prescriber or pharmacist when the combination is uncertain. [1] A prescribed combination may be intentional, but that intention and its monitoring should be clear.
Teach the patient in words they can repeat
- Use the exact medicine and instructions agreed with your clinician or pharmacist. Do not increase the dose because pain persists.
- Do not add a second NSAID yourself. Check the active ingredients, not just the brand name.
- Ask for advice if you become dehydrated, develop vomiting or diarrhoea, or might be pregnant.
- Seek emergency care for vomiting blood, black tar-like stool, severe breathing difficulty, facial or throat swelling, chest pain or sudden stroke-like symptoms.
Use teach-back: “If this medicine is not controlling the pain, what will you do before taking another painkiller?” A clear answer shows whether the safety message has been understood.
A situation that should prompt review
Fictional learning example: A patient requests ibuprofen for back pain. They also mention taking diclofenac earlier and having diarrhoea with poor intake. The immediate nursing task is to clarify the medicines and timing, assess the patient and seek a prescribing or pharmacy review before another NSAID is given. Explain the concern calmly: two medicines from the same class and dehydration may increase harm. Record the assessment, advice and agreed plan.
Effective pain care includes checking benefit, monitoring harm and reassessing the cause of persistent pain. The patient should leave knowing what they are taking, what to avoid and when to seek help.
Sources and further reading
- NHS: NSAIDs.
- NCBI Bookshelf: Nonsteroidal Anti-Inflammatory Drugs (NSAIDs).
- MedlinePlus: Ibuprofen drug information.
- NIDDK: Keeping Kidneys Safe.
- MHRA: NSAIDs and renal impairment.
- FDA: NSAIDs from 20 weeks of pregnancy.
- NHS Specialist Pharmacy Service: NSAIDs monitoring.
Sources checked 1 November 2026. Educational guidance for nurses and students. Follow the approved product information, authorised prescription and current local protocols.