The FDA is slapping a warning label on your go-to pain reliever. Now you can add May cause stroke or heart attack to the list of side effects that nonsteroidal anti-inflammatory drugs, aka NSAIDs, may induce. Turns out drugs such as ibuprofen (Motrin), naproxen (Aleve), diclofenac (Voltaren), and celecoxib (Celebrex) increase the risk of blood clots, elevated blood pressure, cardiac failure, and sudden cardiac death (from arrhythmia). It’s inherent in the way they do their jobs:
To relieve pain, NSAIDs block the synthesis of a protective substance from the blood vessels called prostacyclin, which helps relax the blood vessels and restrain clot formation. “They have the opposite effect of aspirin with respect to heart and stroke risk,” says Sherry Torkos, Phm, a holistic pharmacist based in Ontario, Canada. “A real concern is that because these products are available over the counter, people take them without talking to their pharmacist or reading the information on the package, and the risk of adverse effects is significant.”
NSAIDs may increase the risk of heart attack or stroke in people with or without heart disease or risk factors for heart disease such as high blood pressure or high cholesterol, explains Sanjay Kaul, MD, a cardiologist at Cedars-Sinai Medical Center in Los Angeles who was a member of the FDA’s expert panel that examined all the evidence on the drugs. “So the FDA warning applies even to healthy populations.” (Learn how to avoid the harmful side effects from common medications and get your health back on track with Drug Muggers by pharmacist Suzy Cohen.)
What’s a pain-relief-seeking woman to do? Despite the new findings, experts aren’t saying that we should avoid NSAIDs. As with all medications, Kaul says, there are benefits and risks. How you weigh them and what an acceptable tradeoff is to you is a highly individual choice. Here are a few things you can do to manage your pain and limit your risk:
Make sure you aren’t taking too much.
“The increased cardiovascular risk appears to be greater at higher doses,” says Kaul. “The studies that yielded increased risk typically used daily doses of 2,400 mg for Motrin, 1,000 mg for Aleve, 150 mg for Voltaren, and 200 to 400 mg for Celebrex.”
Look to other ways to control pain.
Kaul tells his patients to restrict their use of these meds to more severe cases of pain, and avoid using them for minor aches and pains, headaches, or fever. “Exhaust all other options for pain control first, such as local heat, pain patches or salves, Tylenol, or aspirin before considering taking these medications,” he says. Torkos points out that while NSAIDs and aspirin have similar benefits, they differ slightly in their mechanism of action. Aspirin is not as widely used in higher doses because of its side effects: upset stomach, bleeding in the stomach, ulcers, and ringing in the ears—many of the same side effects that come with NSAIDs. However, if you’re looking for relief but are concerned about your heart, aspirin may be a good alternative, she says.
Understand the risks.
The FDA’s warning came from studies that found an increase in cardiovascular risk of 10 to 50%. Those numbers may sound scary, but here’s how they play out in real life: For every 1,000 people who are at high risk for vascular events (meaning that they have a 2% chance per year that something will happen) and are taking NSAIDs, seven or eight additional people will have a major event, of which one or two would be fatal. For every 1,000 people who are at low risk (meaning they have a 0.5% chance of vascular event occurring per year), about one or two additional individuals would have a major vascular event, of which fewer than one would be fatal.
The bottom line: Go ahead and keep taking NSAIDs when you’re in a lot of pain, but try to take the lowest dose for the least amount of time possible to minimize your risk.