Patients should consult their physician before taking any additional prescriptions, over-the-counter medications, nutritional supplements or herbal medications. Of particular concern to individuals taking nonsteroidal anti-inflammatory drugs (NSAIDs) are:

• Aspirin. Aspirin increases the chance of developing serious side effects if taken regularly with other NSAIDs.
  
  
• Blood pressure medications. Taking NSAIDs may reduce the effectiveness of these drugs.
  
  
• Triamterene. This diuretic increases the chance of kidney problems when taken with NSAIDs.
  
  
• Cimetidine. This drug, used to treat gastrointestinal disorders, increases the chance of kidney problems when taken with NSAIDs.
  
  
• Chemotherapy drugs. Taking NSAIDs may increase the toxicity of some cancer-fighting drugs.
  
  
• Arthritis, gout or diabetes medication. These drugs can interact poorly with NSAIDs in some instances.
  
  
• Anticoagulants (medications that inhibit the blood’s ability to clot). Taking NSAIDs along with anticoagulants may increase the risk of excessive bleeding.
  
  
• Lithium carbonate. The effect and toxicity of this compound used to treat bipolar disorder may increase when taken along with NSAIDs.
  
  
• Immunosuppressants (medications that suppress the immune system). These may lessen the medicinal effects of NSAIDs.
  
  
• Corticosteroids (anti-inflammatory medications). NSAIDs taken in conjunction with corticosteroids may increase the risk of stomach ulcers.
  
  
• Anti-emetics (medications that prevent or stop vomiting). When used in conjunction with NSAIDs, anti-emetics may not be as effective.
  
  
• Cigarettes and alcohol. Smokers have an increased risk of developing stomach ulcers from NSAID use. When alcohol and NSAIDs interact, nausea and bleeding of the stomach may occur.
  
  
• Vitamin E supplements and omega-3 fatty acid supplements. Each of these increases the likelihood of bleeding when taken along with NSAIDs.
  
  
• Chondroitin. This supplement has a chemical composition similar to anticoagulants.
  
  
• Zinc. Reduces the absorption and effectiveness of NSAIDs.

In addition, NSAID use can decrease melatonin levels in the body.

Supplements that help build cartilage in joints (e.g., chondroitin, glucosamine) may enhance the anti-inflammatory properties of NSAIDs. Copper supplements may bind to NSAIDs and increase their anti-inflammatory properties as well. NSAIDs should never be taken with other pain relievers (analgesics) or anti-inflammatory medications unless under the direction of a physician.

There is conflicting evidence about the effect of other NSAIDs on aspirin. Some studies suggest that some types of NSAID may reduce aspirin’s effectiveness in patients having a heart attack. Other studies have suggested that regular – but not intermittent – use of NSAIDs may have an impact on the effects of aspirin. Additional studies have shown that an NSAID may not reduce an aspirin's effectiveness when the aspirin is taken two hours before the NSAID. It is recommended that if patient is taking ibuprofen for pain control and aspirin for anticoagulation, aspirin should be taken at least two hours before ibuprofen.

It is important for patients to tell their physician all the medications they are taking, whether prescribed or over the counter.