From my perspective as a cardiologist, we cannot ignore the potential link between NSAIDs and cardiovascular adverse events. –William Hopkins, MD
Research has shown that high NSAID doses increased the risk of acute renal failure by 35% compared to low-medium doses. –Vijay Sikand, MD
Family Practice Physician
Since most of the bleeding and serious GI side effects of NSAIDs can be painless, they may go undiagnosed and untreated, unless I’m diligent and know what to look for. –James Scheiman, MD

Hear what your peers are saying about NSAIDs

Expert Insight on Managing Pain With NSAIDs

Perspectives on dose-related risk of NSAIDs from a cardiologist, an emergency medicine physician, a gastroenterologist, and a family practice physician.

What do over 400 of your peers have to say about NSAIDs?

Specialists, nurse practitioners, and primary care physicians from across the country weighed in on the NSAIDilemma. 61% believe NSAIDs are overprescribed at high doses, and 70% said they have discussed the dose-related risks of NSAIDs with their colleagues.7

See evidence of the emerging NSAIDilemma

Research shows risk of serious adverse events is dose related.1-6

Compared to low-medium doses, NSAIDs at high doses:

Download peer perspective white papers on the dose-related risk of certain serious adverse events associated with NSAID use.
  • (*=required)
  • After signing up, you will also receive important updates from NSAIDilemma, including notifications of when new white papers, videos, and other resources are added. Your information will not be shared with any third parties, and you will have the option to opt out from future emails at any time.

    Read about the most recent clinical strategies, data, and guidelines on how to minimize NSAID-associated risks:

    1. NSAIDs and Cardiovascular Risk: An Evolving Clinical Perspective by William Hopkins, MD
    2. NSAID-Associated Risks and the Changing Landscape of Pain Management by Vijay Sikand, MD
    3. NSAID-Induced Gastropathy: Clinical Challenges and Perspectives by Byron Cryer, MD

Understand the context of FDA warnings

Did you know FDA examined more than 180 studies when updating warnings about dose-related cardiovascular risk in 2015?8,9

Key clinical observations and regulatory recommendations from the past 10+ years have helped inform the medical community about the dose-related risks of NSAID use.

Discover why now is the time to take notice and take action

Opioid prescriptions are declining for the first time since 1996, while NSAID prescriptions are on the rise.10,11

As prescribers turn to NSAIDs to manage pain, it is more important than ever before to follow professional recommendations on NSAID dosing and use the lowest effective dosage for the shortest duration.12 Professional medical organizations, advocacy groups, and health agencies that also support this approach include:

  • American Heart Association
  • American College of Rheumatology
  • Osteoarthritis Research Society International
  • National Institute for Health and Care Excellence
  • Health Canada
  • American College of Cardiology
  • National Kidney Foundation
  • American Gastroenterological Association
  • European Medicines Agency
  • England's National Health Service

Spread the word about the dose-related risks of NSAIDs


1. Castellsague J, Riera-Guardia N, Calingaert B, et al; Safety of Non-Steroidal Anti-Inflammatory Drugs (SOS) Project. Individual NSAIDs and upper gastrointestinal complications: a systematic review and meta-analysis of observational studies (the SOS project). Drug Saf. 2012;35(12):1127-1146. 2. McGettigan P, Henry D. Cardiovascular risk with non-steroidal anti-inflammatory drugs: systematic review of population-based controlled observational studies. PLoS Med. 2011;8(9):1-18. 3. Huerta C, Castellsague J, Varas-Lorenzo C, García Rodríguez LA. Nonsteroidal anti-inflammatory drugs and risk of ARF in the general population. Am J Kidney Dis. 2005;45(3):531-539. 4. Coxib and traditional NSAID Trialists’ (CNT) Collaboration; Bhala N, Emberson J, Merhi A, et al. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet. 2013;382(9894):769-779. 5. García Rodríguez LA, Tacconelli S, Patrignani P. Role of dose potency in the prediction of risk of myocardial infarction associated with nonsteroidal anti-inflammatory drugs in the general population. J Am Coll Cardiol. 2008;52(20):1628-1636. 6. García Rodríguez LA, Hernández-Díaz S. Relative risk of upper gastrointestinal complications among users of acetaminophen and nonsteroidal anti-inflammatory drugs. Epidemiology. 2001;12(5):570-576. 7. Data on File. Iroko Pharmaceuticals, LLC. 2016 HCP NSAID Survey. September 2016. 8. US Food and Drug Administration. Drug safety communication: FDA strengthens warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or strokes. Published July 9, 2015. Accessed August 15, 2016. 9. US Food and Drug Administration. Joint meeting of the Arthritis Advisory Committee and the Drug Safety and Risk Management Advisory Committee: nonsteroidal anti-inflammatory drugs and cardiovascular thrombotic risk. Published February 10-11, 2014. Accessed August 15, 2016. 10. Goodnough A, Tavernise S. Opioid prescriptions drop for first time in two decades. The New York Times. May 20, 2016. Accessed August 15, 2016. 11. IMS National Prescription Audit, Total Prescriptions, 2011-2015. 12. US Food and Drug Administration. Public health advisory – FDA announces important changes and additional warnings for COX-2 selective and non-selective non-steroidal anti-inflammatory drugs (NSAIDs). Published April 7, 2005. Accessed August 15, 2016.