Choosing Wisely is an initiative by the ABIM Foundation to identify commonly-used tests or procedures whose necessity should be questioned and discussed. This information was developed by Consumer Reports in cooperation with the American Society of Nephrology.

If you need a painkiller but suffer from high blood pressure, heart failure, or kidney disease, it’s best to steer clear of some commonly used pain relievers. Those include:

Ibuprofen, which is sold under the brand names Advil and Motrin, and also as a generic or store brand. You can buy it without a prescription at the drug store. It’s sometimes combined with other drugs in other over-the-counter products, such as certain cold remedies.

Naproxen, sold under the brand name Aleve and as a generic or store brand. It doesn’t need a prescription, either.

Celecoxib, a prescription drug sold as Celebrex.

All three of those drugs, which are called nonsteroidal anti-inflammatory drugs, or NSAIDs, can ease pain and inflammation. But they are too risky if you have any of those health problems. Here’s why.

They’re bad for high blood pressure.
All NSAIDs can cause or worsen high blood pressure. That increases your chance of having a heart attack or stroke. The drugs can also make some blood pressure drugs less effective. That includes diuretics such as hydrochlorothiazide (Hydrodiuril and generic), ACE inhibitors such as lisinopril (Prinivil, Zestril, and generic) and ARBs such as losartan (Cozaar and generic).

They’re bad for the heart and kidneys.
Long-term use of NSAIDs can make your body hold onto fluid, which can worsen heart failure symptoms, such as shortness of breath, swollen ankles, and a rapid or irregular heartbeat. They can also reduce kidney function. That makes the drugs risky for people who already have kidney disease from diabetes or other causes.

Which painkillers should you consider?
Over-the-counter acetaminophen (Tylenol and generic) is often a good first option for people with high blood pressure, heart failure, or kidney problems. But high doses of that drug can damage the liver, so take the lowest dose that provides enough pain relief, and never take more than 4,000 milligrams (mg) a day. That’s equal to the amount in 12 325 mg pills. If that doesn’t work, ask your doctor about short-term use of stronger narcotic painkillers, such as tramadol (Ultram and generic). But if you have kidney problems, limit your daily dose of tramadol to no more than 200 mg and only take it once every 12 hours to reduce your risk of side effects. If you have epilepsy or take certain antidepressants, such as amitriptyline, fluoxetine (Prozac and generic), or sertraline (Zoloft), skip tramadol because it might increase the risk of seizures.

Managing pain without drugs

Non-drug treatments, such as yoga or massage, can often reduce or even eliminate your need for drugs. Here are some options that can help, depending on your kind of pain.

Back pain
Staying physically active often helps. Acupuncture, massage, physical therapy, and yoga, might work, too. Chiropractic care might also be beneficial.

Cutting back on alcohol and avoiding foods that trigger your headaches might help, as can controlling stress with meditation, relaxation therapy, or other means. Exercise can also help.

Low impact exercise, such as walking, biking, and yoga, can ease pain and improve function. But it’s best to avoid high-impact activities, such as running or tennis, that might aggravate your symptoms.

Regular exercise can help reduce pain and fatigue. Other options to consider include cognitive behavioral therapy—a type of psychotherapy—as well as meditation, and tai chi, which is a form of exercise involving slow, gentle movements combined with deep breathing.