• Do not use NSAIDs in people with:
• A history of hypersensitivity/severe allergic reaction to an NSAID (including aspirin):
• Severe skin reactions and angioedema. Allergies that cause skin reactions and angioedema are absolute contraindications to NSAIDs.
• Asthma. Unless NSAIDs clearly cause severe exacerbations of asthma, people with asthma should not be denied the benefits of NSAIDs without being offered the option of a trial to assess the effect on asthma control.
• Severe heart failure — NSAIDs may impair renal function.
• Severe hepatic impairment (e.g. liver enzyme levels more than three times the upper limit of the normal range; serum albumin < 25g/L ).
• Current treatment for gastrointestinal bleeding, symptomatic peptic ulcer, or gastrointestinal perforation or obstruction.
• Coxibs are also contraindicated in people with ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, moderate or severe heart failure.
• Where possible, avoid using NSAIDs in people with:
• Renal failure, with estimated glomerular filtration rate less than 30–15 mL/min/1.73 m², creatinine clearance less than 30–20 mL/min, or dehydration:
• Check the summary of product characteristics for the manufacturer's recommendation for each NSAID, available at the electronic Medicines Compendium (eMC) (http://emc.medicines.org.uk).
• Ideally, avoid using an NSAID.
• NSAIDs can provoke acute renal failure if given to someone who is dehydrated, especially if they have diabetes.
• NSAIDs should be used with caution in:
• The elderly — increased risk of serious adverse effects such as gastrointestinal bleeding and perforation, which may be fatal.
• People with a history of peptic ulceration (standard NSAIDs contraindicated), or those at high risk of gastrointestinal adverse effects.
• People with inflammatory bowel disease — NSAIDs may increase the risk of developing or cause exacerbations of ulcerative colitis or Crohn's disease.
• People with hepatic impairment — increased risk of gastrointestinal bleeding and fluid retention.
• Dose reduction is recommended for some NSAIDs.
• Check the summary of product characteristics for the manufacturer's recommendation for each NSAID, available at the electronic Medicines Compendium (eMC) (http://emc.medicines.org.uk).
• Renal impairment (avoid if possible) — sodium and water retention may occur leading to a deterioration in renal function and, possibly renal failure. This has also been reported with topical use.
• If the person cannot avoid using a NSAID and has impaired renal function, monitor creatinine clearance or estimated glomerular filtration rate.
• People with heart failure — NSAIDs may impair renal function.
• People with hypertension — NSAIDs may impair renal function.
• In a women trying to conceive — may impair female fertility.
• For information on when NSAIDs can be used during pregnancy, and which are preferred see Can NSAIDs be used during pregnancy?
• For information on when NSAIDs can be used during breastfeeding, and which are preferred see Can NSAIDs be used during breastfeeding?
• Consider the possibility of drug interactions.

In depth