They’re typically called “over the counter” medications (or OTC’s) and include non-steroidal anti-inflammatory drugs (NSAIDs) such as Aleve (Naproxen), Midol (naproxen), Tylenol (Acetaminophen) and they’ve been the go-to “benign” pain medication for years.
They aren’t addictive, (not physically) and it’s not easy to overdose on them (although it’s been tried). In addition, any serious side effects like gastrointestinal ulcers and bleeding seem to be limited to high doses taken for longer periods of time, or to people with significant medical problems.
Even before the era of the opioid epidemic, non-prescription pain relievers were widely used across the country. But then…
➡ In 2004, the manufacturer of the NSAID Vioxx pulled it from the market because the drug was associated with serious cardiovascular problems like heart attacks and strokes.
➡ Soon afterward, a related medication, Bextra, was also discontinued due to cardiovascular risks and potentially fatal skin reactions.
But even after that, not all Non-prescription pain relievers were discontinued.
Some prescription NSAIDs (including Celebrex and some over-the-counter ones (Ibuprofen, Naproxen) were “thought” to be relatively safe.
➡ Despite that, however, multiple studies suggest a clear link between all NSAIDs and heart attacks, strokes, and heart failure.
In 2015, the FDA strengthened the recommended warning on all NSAIDs.
The revised warnings say:
“Non-prescription pain relievers can increase the risk of heart attack or stroke in patients with or without heart disease or risk factors for heart disease.”
A large number of studies support this finding, with varying estimates of how much the risk is increased, depending on the drugs and the doses studied.
Here is the latest research on non-prescription pain relievers and your heart:
- In 2016, European researchers published a study linking NSAIDs to an increased risk of heart failure.
They looked at almost seven million people who had been given prescriptions for 27 types of NSAIDs.
They found that people taking NSAIDs had a 20% higher risk of heart failure compared to people who were not using them; the higher the dose of NSAIDs, the greater the risk.
- A recent Danish study showed an increased risk of cardiac arrest among people who took NSAIDs within the previous month.
➡ They identified 29,000 cases of cardiac arrest deaths and linked these to earlier diagnoses and prescription data using population-level databases.
A careful analysis found that just over 3,300 patients had taken NSAIDs for the month prior to death, and any NSAID use was associated with a 31% increased risk of cardiac arrest.
- The NSAIDs diclofenac (given for Rheumatoid Arthritis) and Ibuprofen (known as Advil and Motrin IB) were associated with a 50% and 31% increased risk, respectively.
“The findings are a stark reminder that NSAIDs are not harmless,” warned study author Professor Gunnar Gislason in a press conference:
So, now what?
We need a lot more discussion about non-prescription pain relievers and your heart…
➡ While some doctors recommend caution for patients at risk for heart attack, stroke, and heart failure, NSAIDs are still widely prescribed, even to patients with significant risk factors.
This is partly because they are good at relieving many types of pain. And they are easily available, from pharmacies to airports to gas stations to big-box discount warehouses.
Right now, anyone can pick up a two-pack of 200-mg ibuprofen tablets with 500 per bottle — that’s 1,000 tablets!
So, does everyone need to stop using all NSAIDs? No.
But, some things have to change:
• People at particularly high risk need to be aware that these drugs (either prescribed or over the counter) may not be safe for them.
• These medications probably should not be available for purchase in massive quantities, as that makes most average consumers think that they’re safe to take in large quantities and for longer periods of time.
If you have taken NSAIDs regularly for chronic pain or to reduce inflammation, a word of caution:
Speak to your physician (s) about these risks, make sure to consider any history of heart disease, no matter how mild, do your own research…then decide for yourself if the risk of continuing to take them, other than for intermittent headaches or physical pain, is worth it.
As always, don’t follow blindly when it comes to your health. Do your homework.
And remember, you’re welcome to send me your questions anytime by clicking the “Get In Touch” tab at the top of any page. These communications come directly to me and are strictly confidential for your safety.