NSAID side effects, risk, danger, safety and benefits for pain management, increased risk for heart attack
August 17 2017 by
Ray Sahelian, M.D.

Nonsteroidal anti-inflammatory drugs are used to relieve some symptoms caused by arthritis, such as inflammation, swelling, stiffness, and joint pain. However, they do not cure arthritis and will help relieve pain only as long as you continue to take them. NSAIDs may possibly interfere with healing of joints after an injury.

NSAID relief of pain
These medications are used to relieve other kinds of pain or to treat other painful conditions, such as: gout attacks; bursitis; tendinitis; sprains, strains, or other injuries; or menstrual cramps. Ibuprofen and naproxen are also used to reduce fever. Meclofenamate is also used to reduce the amount of bleeding in some women who have very heavy menstrual periods.

During colds and flu these medications can be used to treat general body and muscle aches.

Dental pain relief can be achieved by taking 600 mg of naproxen (Aleve). If you have any kind of dental work, take 600 mg an hour before dental work and again a few hours later. I prefer this approach to taking codeine pills.

NSAID side effects, danger, safety, risk, caution
Many side effects are caused by NSAIDs including toxicity to the kidneys, ears, and stomach. They can also interfere with proper healing. They reduce the flow of blood to the kidneys and impair their function. The impairment is most likely to occur in patients with preexisting impairment of kidney function or congestive heart failure, and use in these patients should be done cautiously. Children are also susceptible to such harm. People who are allergic to other NSAIDs, including aspirin, should not use ibuprofen. Individuals with asthma are more likely to experience allergic reactions to ibuprofen and other NSAIDs. Common anti-inflammatory drugs such as ibuprofen and naproxen may increase the chance of miscarriage if they are taken early in pregnancy.

Some can cause insomnia, such as Naprosyn (naproxen) when taken in the evening.

FDA is warning about painkillers like ibuprofen, saying they do raise the risk of heart attack or stroke. The warning covers drugs called nonsteroidal anti-inflammatory drugs or NSAIDS for short. They include ibuprofen, sold under brand names like Advil or Motrin; naproxen (Aleve), as well as prescription arthritis drugs known as COX-2 inhibitors, such as Celebrex.

NSAIDs and heart disease, cardiovascular health
May 2017 -
Motrin, Advil and Aleve increase the risk for a heart attack, even in the first month of use, and the risk is increased with higher doses. NSAIDs are widely used to treat pain and inflammation as a relief for arthritis and other joint diseases and short-term conditions such as menstrual cramps, fever from a cold or flu or the occasional backache or headache.

High doses of some traditional non-steroidal anti-inflammatory drugs (NSAIDS) such as Motrin are associated with similar cardiovascular risks and heart attack as the new generation of anti-inflammatory drugs known as cyclooxigenase 2 (COX 2) inhibitors (like Vioxx, Celebrex, Bextra). Researchers from the UK and Italy performed a combined analysis (known as a "meta-analysis") of all the available randomised trials that compared a COX 2 inhibitor with placebo, or a COX 2 inhibitor with a traditional NSAID, and had recorded serious cardiovascular events. The study showed, as expected, that, COX 2 inhibitors were associated with an increased risk of vascular events, mainly heart attack. Unfortunately, there were insufficient data to reliably assess whether these risks were dose dependent, or whether the risks might differ among aspirin and non-aspirin users. But the study also showed that high doses of two of the NSAIDs studied, diclofenac and ibuprofen, were associated with a similar increase in the risk of vascular events to COX 2 inhibitors, although the risks of high doses of another NSAID, naproxen, were smaller. However, the average increased risk of vascular events was modest among the people studied in the trials: For every 1,000 people taking an NSAID or COX 2 inhibitor, around three extra people per year would have a vascular event, most likely a heart attack.

NSAIDs significantly increase the risk of cardiovascular events in patients who take them regularly. "These drugs have some use in the treatment of chronic pain," says Peter Jüni, MD, head of the division of clinical epidemiology at The University of Bern in Switzerland. "But they have safety issues. In the signals we saw, there was a two- to fourfold increase in the risk of myocardial infarctions [heart attacks], stroke, or cardiovascular death, and these are, clinically, considerable increases in risk." January 2011.

For patients with existing heart failure, use of NSAIDs should either be avoided or withdrawn when possible.
A recommendation from the American Diabetes Association suggests that metformin not be used in patients with heart failure.

Heart failure
Use of nonsteroidal anti-inflammatory drugs by patients with chronic heart failure is associated with increased risk of death and cardiovascular illness. Archives of Internal Medicine, 2009.

Stomach bleeding
2009 - FDA announced painkillers known as non-steroidal anti-inflammatory drugs will carry bold warnings about the risk of stomach bleeding. Such drugs include Bayer AG's aspirin products, Wyeth's Advil and Johnson & Johnson's Motrin.

Taking more than one NSAID is risky
People who use two or more non-steroidal anti-inflammatory drugs to help control pain have a worse health-related quality of life than their peers who use only one. Arthritis and Rheumatism, February 2008.

Types of NSAIDs
Diclofenac - patients with an underlying heart condition, such as heart failure, heart disease or circulatory problems, or patients who have previously suffered heart attacks or strokes, should not use diclofenac.
Ibuprofen (Motrin, Advil)
indomethacin (Indocin)
Naproxen (Naprosyn) sold over the counter as Aleve
Meloxicam (Mobic) - In 2006,  Boehringer Ingelheim’s Mobic was approved as a generic NSAID for the treatment of osteoarthritis.
   The Food and Drug Administration in 2015 approved a low-dose formulation of meloxicam for the treatment of osteoarthritis pain, according to manufacturer, Iroko Pharmaceuticals. The new medication is Vivlodex.

NSAIDs and knee injury
Treatment with low-intensity pulsed ultrasound can hasten the healing of torn ligaments in the knee, while the use of NSAID drugs, such as Celebrex (celecoxib) and Motrin (ibuprofen), has the opposite effect, findings from an animal study suggest. Ligaments are strong fibrous bands that connect bones and help control their range of motion. They are closely related to tendons, which connect muscles to bone.

Heavy exercise an physical activity
Taking non-steroidal anti-inflammatory drugs NSAIDs like ibuprofen during endurance events does not help prevent muscle damage or next-day muscle soreness

NSAID drugs and prostate gland
Common NSAID painkillers like ibuprofen and naproxen may lower the risk of developing an enlarged prostate and worsen urinary symptoms in men who already have the condition.

References:
Do cyclo-oxygenase-2 inhibitors and traditional non-steroidal anti-inflammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trials. BMJ Volume 332, pp 1302-5.
Editorial: Life without COX-2 inhibitors BMJ Volume 332, pp 1287-8.

Questions
When I take aspirin or ibuprofen, I notice a reduction in urination for a number of days, accompanied by edema and weight gain, followed by fewer days of diuresis and weight loss. Because NSAIDS can be nephrotoxic and appear to affect me, I no longer take them. But I could use a natural anti-inflammatory of some kind. Do you have suggestions?
   We can't make specific suggestions, but you could read the info on the antiinflammatory page.