Patients may be advised by their physician not to take nonsteroidal anti-inflammatory drugs (NSAIDs) if they have any of the following conditions:

• Aspirin sensitivity. People who have an allergic reaction to aspirin often have sensitivity to other NSAIDs as well. An allergic reaction to NSAIDs can be serious and result in life-threatening anaphylactic shock. Individuals who have an allergic reaction to NSAIDs should seek immediate medical attention.
  
  
• Heart problems. COX-2 inhibitors, a subclass of NSAIDs, have been linked to increased stroke and heart attack risk. For this reason, two of these medications (rofecoxib and valdecoxib) have been withdrawn from the market. In addition, some NSAIDs may worsen heart failure, increase blood pressure, increase the risk of a second heart attack and reduce the effectiveness of some heart medications. People with heart problems should consult their physician about taking NSAIDs regularly. Some patients are advised by a cardiologist to take a small dose of aspirin daily to reduce their risk of heart attack or stroke.
  
  
• Stomach problems. NSAIDs can alter stomach chemistry and enzymes, causing irritation. Serious problems can develop (e.g., gastric ulcers, stomach bleeding) if this alteration is prolonged.
  
  
• Kidney or liver problems. NSAIDs are potentially damaging to these organs if taken in high doses or for extended periods of time. Conditions that may cause kidney damage include systemic lupus erythematosus, sickle cell anemia and diabetes.
  
  
• Hives (red, swollen patches of skin). Using NSAIDs can worsen this condition.
  
  
• Fluid retention (edema). Using NSAIDs may increase fluid retention, especially in the feet and ankles. Individuals with edema should avoid using NSAIDs.
  
  
• Inflammatory bowel disease (IBD). NSAIDs can trigger this condition. However, two recent studies suggest that patients may be able to take COX-2 inhibitors briefly without causing their IBD to flare up.
  
  
• Nasal polyps (round pieces of tissue that extend into the nasal cavity). The use of NSAIDs can complicate this condition in certain populations.
  
  
• Ulcers, sores or white spots in the mouth. Developing sores in the mouth while taking NSAIDs often indicates the medicine is causing serious side effects. If sores are present before the medication is started, it can be harder to detect serious side effects.
  
  
• Asthma. Recent research suggests that regular use of aspirin might reduce the risk of developing asthma. However, people who have asthma are generally advised to avoid NSAIDs because the drugs can trigger attacks. This occurs because the drugs interfere with the body’s production of the COX enzyme. Though the mechanism is unclear, it appears that the disruption of COX results in the constriction of the airways. Because of this sensitivity, physicians recommend that patients with asthma use acetaminophen in place of NSAIDs. However, patients sensitive to NSAIDs may also have reactions to acetaminophen and should discuss its use with their physician. People with asthma often also have problems with chronic sinusitis or nasal polyps. A physician may determine that an individual with asthma is able to tolerate COX-2 inhibitors.
  
  
• Gout or bleeding disorders. Patients with these conditions may be advised by their physician to avoid taking NSAIDs.
  
  
• Parkinson’s disease. NSAIDs should not be used in conjunction with several of the medications commonly prescribed to treat Parkinson’s disease, unless prescribed by a physician.
  
  
• Mental illness. Because NSAID use may cause some psychiatric medications to become toxic in the body, they should be used only with a physician’s prescription.

Patients should generally not take NSAIDs before undergoing surgery. These medications prevent blood clotting, which is necessary for healing wounds.