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    NSAID Overdose – Treatment

    Inflammatory, Substance Use, Toxicology

    Last Updated Jan 25, 2022
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    By Karine Badra-Quirion, Nora Tong


    Nonsteroidal anti-inflammatories (NSAIDs) are commonly used for pain management, inflammation, and fevers. Given the widespread availability, overdose is common.

    NSAID overdose can cause nephrotoxicity, gastrointestinal toxicity, neurological toxicity, hematological abnormalities, or biochemical abnormalities and needs to be managed appropriately in an ED setting.

    Ingestions of less than 100mg/kg are unlikely to result in toxicity whereas ingestions greater than 400mg/kg have a significant risk for toxicity.

    Recommended Treatment

    Patients with minor overdoses experience mild gastrointestinal symptoms which are self-limiting. There is no antidote for NSAIDs. Treatment in patients who are symptomatic is supportive. Patients who have ingested NSAIDs within 1-2 hours of presentation may be administered activated charcoal in cases of large ingestions or if symptomatic.


    • Monitor for a minimum of 4 hours in patients who ingested a standard release preparation.
    • Monitor for a minimum of 8 hours in patients who ingested a sustained-release preparation.


    • Lab investigations include CBC, INR/PTT, electrolytes, renal function, liver function, and acid-base status
    • Consider screening for coingestants.


    Resuscitation (2)

    • Ensure an adequate airway, breathing, and circulation in patients with more severe presentations that include mental status changes or unstable vital signs.
    • Patients may require intubation or IV fluids.


    • Significant vomiting –IV fluid rehydration. 
    • Persistent or severe nausea and vomiting – anti-emetics. 
    • Persistent upper gastrointestinal symptoms that do not settle after a few hours of ingestion – proton pump inhibitor (7-day course).


    • Patients with poor renal function or persistent acidosis despite medical management – hemodialysis or hemofiltration.
    • Metabolic acidosis that is unresponsive to fluid resuscitation- IV sodium bicarbonate 1 ml/kg 8.4% solution.
    • Correct electrolyte abnormalities


    • Seizures that do not terminate spontaneously within 1-2 minutes – IV benzodiazepines.
      • Diazepam10-20 mg in adults, 0.1-0.3 mg/kg body weight in children.
      • Lorazepam4 mg in adults, 0.1 mg/kg in children.

    Criteria For Hospital Admission

    • Severe symptoms – mental status change, renal dysfunction, severe acidosis.
    • Patients who are suicidal.
    • Large amounts of sustained-release NSAIDs ingested (>6 g in adults, 400 mg/kg in children).

    Criteria For Close Observation And/or Consult

    • Assess for suicide risk and co-ingestion in patients with intentional overdoses.
    • A longer observation period may be required for NSAIDs with a longer half-life.

    Criteria For Safe Discharge Home

    • Asymptomatic with normal vital signs – can be after a 4- to 6-hour observation period in children who have ingested less than 100 mg/kg.

    Quality Of Evidence?


    Monitor for a minimum of 4 hours in patients who ingested a standard release preparation of NSAIDs.


    Monitor for a minimum of 8 hours in patients who ingested a sustained release preparation of NSAIDs.


    Activated charcoal can be administered in cases of large ingestions of NSAIDs or if symptomatic, presenting within 1-2 hours of ingestion.


    Related Information

    Reference List


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