Dangers of NSAIDs: Over the Counter Doesn't Mean Safe
The last time I walked through a Costco, I was shocked at the huge amounts one can buy of almost anything. Two jumbo bottles of A-1 Sauce, a 20 lb bag of Basmati rice, and two bottles with 1,000 caps each of ibuprofen. “What! Who’s taking all that dangerous medication?”, I wondered. Well, everyone. Americans are in pain and we like to squash the symptoms rather than take a look at what might be causing the pain. The problem is though, ibuprofen is dangerous. So are aspirin and Tylenol.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are assumed to be well tolerated and are widely used for inflammation. NSAIDs range from over the counter to prescription brands and are one of the most widely used class of drugs, constituting more than 70 million prescriptions and 30 billion over-the-counter sold annually in the United States.
NSAIDs work to reduce inflammation without the use of steroids (hence the term nonsteroidal). They inhibit the body’s ability to synthesize prostaglandins, which are a family of hormone-like chemicals, some of which are made in response to cell injury. While NSAIDs can temporarily relieve inflammation, they are not generally safe to use. They can cause major gastrointestinal (GI) complications and even death due to toxicity. Worse, most people get no warning signs of the internal damage caused by NSAID use. NSAIDs also increases the risk of congestive heart failure (CHF), stroke, and heart attack.
Common over-the-counter NSAID names include:
- Ibuprofen (Advil®)
- Naproxen (Aleve®)
- Aspirin (Bayer®)
Prescription brands include:
- celecoxib (Celebrex®)
- diclofenac (Voltaren®)
- etodolac (Lodine®)
- fenoprefen (Nalfon®)
- indomethacin (Indocin®)
- ketoprofen (Orudis®, Oruvail®)
- ketoralac (Toradol®)
- oxaprozin (Daypro®)
- nabumetone (Relafen®)
- sulindac (Clinoril®)
- tolmetin (Tolectin®)
- rofecoxib (Vioxx®)
NSAIDs can cause ulcers, GI damage, and internal bleeding. Those same prostaglandins that cause inflammation, also stimulate the secretion of digestive juices. So we take these little acid pills and then turn off our digestive juices. Ulcers result. Over 50% of all bleeding ulcers are caused by NSAIDs, according to Byron Cryer, a gastroenterologist and spokesperson for the American Gastroenterological Association. Even worse - it is common to develop a stomach ulcer from taking NSAIDs without any warning signs. According to a 1998 issue of the American Journal of Medicine, around 107,000 patients are hospitalized annually due to GI complications from NSAID use, and that is a conservative estimate! Approximately 16,500 deaths per year among arthritis patients alone are linked to NSAID use, according to a 1999 article from New England Journal of Medicine.
Congestive Heart Failure
NSAID use has been linked to Congestive Heart Failure (CHF), heart attack, and stroke. Even with short term use, the risk of a cardiac event increases as early as within the first week of starting to take the NSAID. Congestive heart failure risk is increased substantially when using NSAIDs, especially with those already at risk for heart disease. And several studies have shown that the risk for CHF was two-fold when NSAIDS were taken in conjunction with diuretics.
If You Must Use NSAIDs
In general, I tell my patients that NSAIDs should be used for emergencies only. Treatment should be very short in duration, using as low of a dose as possible, to reduce risk. If you absolutely must take an NSAID, make sure you use a low dose and take it for very short periods of time only (2-3 days, tops!). It’s better to address the cause of the problem than the symptoms. Turning off the symptoms is akin to unscrewing the light bulb on your oil light in your car. Pain is your body’s way of telling you that something is wrong. When you turn that signal off, it doesn’t solve the problem, and can create more problems.
If you’re using the NSAID for a fever, consider this. Your body turns the heat up to kill the bacteria or virus. When you turn that fever down with an NSAID, you are prolonging the life of the bacteria or virus, thus prolonging your sickness. Of course, if the fever is 104 or higher, it’s probably a good idea to bring it down. But let a low-grade fever run its course and do what it’s supposed to do - kill the sickness.
Just because a product is for sale over the counter, it does not necessarily mean that product is safe for use. NSAIDs are very popular and are often taken at the first sign of inflammation, fever, or pain. However, lots of research has come out within the last 20 years explaining the dangers of NSAID use: They damage the GI tract, can prolong illness, and increase the risk of cardiac events. This risk is higher for patients who have heart disease or are taking diuretics, but can affect everyone, even after just one week of exposure.
Are you experiencing pain or currently using NSAIDs and want to stop but aren’t sure how? Give us a call to schedule your free consultation and we will tell you how we can help. You can schedule via email at firstname.lastname@example.org or by calling 510-922-1579 to make an appointment. Or, feel free to text us at 510-292-9948.
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