Steroids and painkillers

If you're taking steroids like prednisone or prednisolone, picking the right painkiller is important. Steroids can irritate your stomach over time and make side effects from other drugs, like NSAIDs (non-steroidal anti-inflammatory drugs), much worse.

Why NSAIDs are risky

NSAIDs (like ibuprofen, naproxen, and aspirin) are common painkillers, but combining them with steroids increases the risk of stomach ulcers, bleeding, high blood pressure, and heart problems. Unless absolutely necessary, avoid using NSAIDs while taking steroids.

Safer pain relief options

Acetaminophen (also known as paracetamol): This is usually the safest first choice. It helps with mild to moderate pain and doesn’t cause ulcers or raise blood pressure. Stick to the correct dose (no more than 2,000 mg per day) to protect your liver.
Topical NSAIDs: For pain in a specific area, creams or gels (like diclofenac gel) can provide relief with fewer side effects than tablets.
Other therapies: Physical therapy, heat or cold packs, and, in some cases, carefully monitored mild opioid use may help, but should be discussed with your doctor.

Protecting your stomach

If you must take an NSAID, your doctor may also prescribe a proton pump inhibitor (PPI) like omeprazole to protect your stomach. Always take NSAIDs with food and use the lowest dose for the shortest time possible.

Warning signs to watch for

Call your doctor or seek emergency help if you notice:

Black, tarry stools
Vomiting blood or "coffee-ground" material
Severe stomach pain
Chest pain or sudden shortness of breath

Steroids can mask pain, so visible signs like blood in stool or vomit should never be ignored.

Quick tips

Prefer acetaminophen or paracetamol for everyday pain
Use topical treatments when possible
Avoid NSAIDs unless advised otherwise
Ask about stomach protection if NSAIDs are needed
Stay alert for warning symptoms

With the right painkiller choices, you can manage your pain safely while protecting your stomach and heart.

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