Nonsteroidal anti-inflammatory drugs (NSAIDs) are some of the most commonly used medications. They help relieve pain, inflammation, and fever. Many NSAIDs are available over the counter, including ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin. However, these widely accessible medications carry many serious, potentially life-threatening risks. For example GI bleeding or ulcerations, kidney toxicity, and increased blood pressure. NSAIDs also increase the risk of heart attack or stroke, especially for patients who have heart disease.  

If you have heart failure, you might remember the doctor telling you to avoid all NSAIDs. That’s because NSAIDs cause kidneys to retain salt and water, which leads to fluid overload. In heart failure, there is already fluid build up because the heart cannot pump as effectively, and many patients struggle with shortness of breath and edema because of it. These excess fluids caused by NSAIDs are an extra burden for the weakened heart, which can exacerbate heart failure. Studies show heart failure patients who use NSAIDS are more likely be hospitalized and die.  


There are Other Options! 

To help ease the pain, there are options such as cold compresses, massage, physical therapy, and meditation that are safe. Let your doctor know about any persistent pain that’s bothering you. After careful evaluation, they might suggest other medication that’s appropriate for you, such as acetaminophen (Tylenol), a topical pain reliever, or prescription medication.  


In addition to NSAIDs, certain steroids, stimulants, diabetes, and cancer medication can also cause or worsen heart failure. Always talk to your pharmacist or doctor before starting any new medication, whether it is prescription or over-the-counter. We are happy to provide a thorough check and recommend safer alternatives. 


Prepared by Wenye Dang PharmD 


  • Solomon D. NSAIDs: Adverse cardiovascular effects. UpToDate. 
  • Varga Z, Sabzwari SRA, Vargova V. Cardiovascular Risk of Nonsteroidal Anti-Inflammatory Drugs: An Under-Recognized Public Health Issue. Cureus. 2017;9(4):e1144. Published 2017 April 8.