• The risks of adverse effects vary among individual NSAIDs and are also often influenced by the dose and duration of use.
• Adverse effects may be minimized by using the lowest effective dose for the shortest duration necessary to control symptoms.
• Children appear to tolerate NSAIDs better than adults and gastrointestinal adverse effects are less common.
• The most common adverse effects of nonsteroidal anti-inflammatory drugs (NSAIDs) are:
• Dyspepsia and other upper gastrointestinal complications such as ulcer, perforation, obstruction or bleeding.
• For detailed information about who is at risk of how they can be managed, see the section Gastrointestinal adverse effects.
• Other less common adverse effects include:
• Cardiovascular and renal complications such as myocardial infarction, stroke, cardiac failure, hypertension, and renal failure are less common but serious adverse effects associated with NSAIDs.
• For detailed information about who is at risk of how they can be managed, see the section Cardiovascular and renal adverse effects.
• Prolonged bleeding (for example after surgery) because of platelet inhibition.
• Asthma — NSAIDs may exacerbate or precipitate asthma.
• Stop the NSAID if is suspected to have precipitated bronchospasm.
• Severe skin reactions and angioedema — stop the NSAID.
• Very rarely, NSAIDs can precipitate severe hepatic reactions (such as hepatitis, liver necrosis, or hepatic failure).
• If there are symptoms or signs of liver damage (e.g. nausea, vomiting, abdominal pain, jaundice), or persistently abnormal liver enzymes, stop the NSAID.

These recommendations take into account advice from the Medicines and Healthcare products Regulatory Agency (MHRA) and its independent adviser, the Commission on Human Medicines (CHM) [CSM, 2003; CSM, 2005; CHM, 2006; MHRA, 2007; MHRA, 2009b], the manufacturers' Summaries of Product Characteristics [ABPI Medicines Compendium, 2008; ABPI Medicines Compendium, 2009a; ABPI Medicines Compendium, 2009b; ABPI Medicines Compendium, 2010a; ABPI Medicines Compendium, 2010b] and the British National Formulary [BNF 59, 2010].

• Asthma. Exacerbation of asthma is not often associated with the use of NSAIDs, but NSAIDs are a risk factor for severe exacerbations of rapid onset [Lesko et al, 2002; Plaza et al, 2002; Debley et al, 2005].
• Liver adverse effects of coxibs. Recommendations on general strategies for safe and effective prescribing are pragmatic advice based on the summary product characteristics for celecoxib and etoricoxib [ABPI Medicines Compendium, 2009a; ABPI Medicines Compendium, 2008].